An ICB in the North West of England offered GPs flexibility on delivering locally commissioned services as over winter to ‘prioritise their workload as they see fit’.
Between December and the end of February, Lancashire and South Cumbria ICB offered a flexible arrangement which allowed practices to focus on ‘immediate same day pressures’.
The ICB promised this arrangement would not financially disadvantage practices by ensuring they receive income for activity-based payments that is equal to their highest quarter achievement in the first three quarters of 2022/23.
The flexibility included ‘redirecting capacity from the delivery of locally commissioned services’, which included local enhanced services and general practice quality contracts, however the ICB did not specify exactly which services this covered.
A spokesperson for the ICB said: ‘Practices won’t be financially penalised but the detail of which services have been deprioritised is at the discretion of practices in conjunction with place leads.’
Lancashire and Cumbria LMCs chief executive Peter Higgin told Pulse the support was agreed after Christmas because the ICB ‘recognised the pressure practices are under’, particularly due to Strep A demand.
However, he highlighted the difficulties of offering this flexibility across the whole ICB area, adding: ‘The circumstances are different across all the old CCG areas, so how it works in practice has to be worked out separately, and that work hasn’t been done.’
The ICB is not currently aware of how many practices took advantage of this flexibility, but said it will have a better picture by the end of this month.
A spokesperson added: ‘We recognised that historically CCGs have commissioned some differing local enhanced services and also that practices were experiencing differing pressures and consequently provided flexibility for local decision-making based on some principles.’
Dr Ann Robinson, GP partner for Withnell Health Centre in Chorley, said she was not aware of the flexibility offered by the ICB between December and February so her practice had not taken advantage of it.
She said it would have benefitted her practice because they are ‘struggling’, with ‘on the day demand just taking over from everything else’.
The ICB said practices were made aware of the offer in the GP newsletter that goes out from the ICB to all GP practices in the area.
The newsletter edition from 16 February seen by Pulse gave some details of the ICB’s support for practices to re-prioritise their workloads ‘to manage the considerable pressures being faced’.
It laid out the ICB’s broad approach: ‘For activity based payments we’ll ensure that practices receive income in January and February which is equivalent to their highest quarter achievement in quarter 1, 2 or 3 of 2022/23.
‘We’ll monitor actual activity in January and February and if any practice exceeds this achievement we’ll increase the income accordingly at the year end.
‘For any non-activity based payments we’ll provide flexibility for local primary care teams (in conjunction with place clinical directors) to respond to any local requests for income adjustments due to the need to reprioritise workload.’
When asked why the arrangement stopped at the end of February, the ICB said it ‘was a short-term offer to mitigate general pressures being experienced, including respiratory’.
This comes as Kent and Medway ICB have offered practices flexibility on QOF delivery due to increased demand over the winter period.
The scheme aims to ‘maintain the viability of practices’ who ‘due to the exceptional levels of acute demand have had to delay their Chronic Disease management reviews’, according to Kent LMC.
A spokesperson for NHS Kent and Medway ICB, recognising that QOF is a national contract and cannot be determined locally, said: ‘We have offered a range of supportive approaches for practices and PCN’s.
‘These include funding to provide additional resources and capacity, overflow hubs to help manage patient demand and allowing some flexibility on local schemes where possible.’
Pulse has previously reported that several ICBs have agreed to meet shortfalls in QOF for GP practices asked to focus on urgent demand.