What a way to start the year. A new GP contract was agreed by NHS England and, er, NHS England in March without the backing of the BMA’s GP Committee, and imposed on GP practices the following month.
The contract, issued by NHS England on 6 March, set out a number of requirements and changes, with access one of the key themes. It focused heavily on ensuring patients have a better experience when contacting their practice or accessing GP services.
For example, practices are now contractually bound to offer patients a needs assessment on first contact or to signpost other ‘appropriate services’. The document was scant on detail, other than prohibiting practices from asking patients to come back another time, and focusing on providing appointments within two weeks. NHS England primary care director Dr Amanda Doyle later cleared up (a little) what was meant in an exclusive interview with Pulse, where she said: ‘We don’t want practices routinely diverting patients to 111 when they are open.’
By March 2024, PCNs must demonstrate that they have, in fact, made improvements to access in order for ICBs to be awarded £78.3m of the investment and impact fund (IIF), with the majority (70%) having been allocated in monthly payments during 2023/24.
And, after data safeguarding concerns put paid to the intended roll-out last November, practices were given until 31 October this year to offer access to prospective patient records.
Following last year’s pause and a subsequent phased roll-out, NHS England announced in December that 4,500 practices (81.1%) now offer automatic access, covering 23.5 million patients.
Finally on access, the contract made provisions for the move from analogue to digital telephone lines, mandating that practices must switch to cloud-based telephony, purchased from a national framework, by the end of 2025.
The focus on digital telephony will improve functionality for practices and patients, the contract said, such as providing call-back and call queuing services and enabling better information management that will help practices to be more responsive.
Also subject to change in the new contract was QOF. A consultation launched this month put the wheels in motion for an end to QOF. As well as a review of the current system ahead of a planned overhaul in 2024/25, some tweaks to this year’s activity were aimed at streamlining things.
New indicators include two on cholesterol, worth £36m, and one on mental health, with one on the percentage of patients on anticoagulation therapy due to be replaced by a similar indicator in the IIF.
Under changes to the additional roles reimbursement scheme, NHS England added two new roles – advanced clinical practitioner nurses and apprentice physician associates – and doubled the number of advanced practitioners PCNs with 100,000 or more patients could hire from three to six.
With no real increase in funding to support the changes imposed on general practice, reaction from all corners was, predictably, disdainful.
NHS England was accused of creating an ‘irreparable situation for practices and their patients’, of viewing GPs ‘as a profession who need to be beaten into submission’, and of delivering ‘a kick in the teeth’ and ‘one of the final nails in the coffin’.
One possible ray of hope might have been the prospect of a brand-new five-year deal in 2024, when the current five-year contract comes to an end.
However, those hopes were soon dashed. NHSE’s national director of primary and community care services, Dr Amanda Doyle, told Pulse that limited funding would prevent a new five-year contract from next year.
Instead, a meagre one-year deal for 2024/25 – which Dr Doyle described as a ‘stepping stone’ – would likely be implemented, thanks to just one year’s worth of funding being available.
This blow came after the BMA’s GP Committee had voted against industrial action over the contract imposition, choosing to wait and see how negotiations for 2024/25 onwards panned out.
Now that any such negotiations appear to be off the table, the path may be cleared for GPs to take the plunge and walk out in protest.
Less a stepping stone, more a millstone.
