NHS England and NHS Improvement today (1 March) announced that GPs in England’s PCNs will be required to open from 9am to 5pm on Saturdays from October under new enhanced access arrangements.
The full letter is as follows:
General practice contract arrangements in 2022/23
General practice teams responded swiftly and fully to the Government’s request that they reprioritise their work to support the COVID booster programme. Thank you to all those working in general practice for the agility and responsiveness that was shown over these past few months. Your contribution is recognised, valued and appreciated.
As we look ahead, the needs of our populations and patients necessitates that the primary focus of general practice returns to addressing non-COVID needs. In particular this needs to be on long-term condition management and chronic disease control, ensuring timely access for patients with urgent care needs, and regaining momentum on the wider Long Term Plan prevention agenda. Responding to COVID, including COVID vaccinations, will continue to be an important subset of activity but on a smaller scale than in 2021/22. The British Medical Association (BMA) and the Royal College of General Practitioners (RCGP) set out guidance at the end of last year stating ‘we must reassure the public that general practice remains open and that patients will be seen face to face where it is clinically appropriate’, which remains in place.
2022/23 also sees the formal start of NHS Integrated Care Boards, subject to parliament. The success of Integrated Care Systems (ICSs) is dependent on successfully supporting and developing primary care, enabling it to be sustainable and more joined-up with other services. The stocktake led by Dr Claire Fuller will set out what all ICSs need to do locally, with a particular focus on development of Primary Care Networks (PCNs) so that their potential benefits can be fully realised.
NHS England and NHS Improvement and the Government continue to remain committed to honouring the 5-year settlement that runs to 2023/24, negotiated and agreed with BMA General Practitioners Committee (GPC England) and subsequently enhanced. Through nationally guaranteed entitlements, this provides significant real terms growth in overall investment for general practice.
The GP contract regulations will be updated in 2022/23 with the intention to make the following changes:
- in light of the new models of access to general practice which have been developed during the pandemic, there will be a change to the existing contractual requirement that at least 25% of appointments are available for online booking. The existing requirement, currently drawn from the totality of a practice’s appointments, is too crude. It will be replaced with a more targeted requirement that all appointments which do not require triage are able to be booked online, as well as in person or via the telephone. Guidance will be issued on what type of appointments practices are expected to be made available for online booking;
- to require GP practices to respond to Access to Health Records Act (AHRA) requests for deceased patients and to remove the requirement for practices to always print and send copies of the electronic record of deceased patients to Primary Care Support England (PCSE). It is expected that the savings from not having to print and send the electronic record will far outweigh the additional burden of managing a small number of AHRA requests;
- there will be some minor changes to vaccinations and immunisations in 2022/23 (set out at Annex A) which reflect forthcoming changes to the routine vaccination schedule recommended by the Joint Committee on Vaccination and Immunisation (JCVI), including: o human papillomavirus (HPV) o MMR including support for a national campaign o MenACWY Freshers programme;
- there will also be continuation of funding in Global Sum (£20 million) for one additional year (2022/23) to reflect workload for practices from Subject Access Requests (SARs). The original 5-year deal had assumed that this funding would cease beyond 2021/22; and 3
- to support the modernisation of GP registration there will be a clarification of the ability for patients to register digitally.
No new additional indicators will be added to QOF when the temporary income protection arrangements come to an end in March 2022. The Quality Improvement (QI) modules for 2022/23 will focus on optimising patients’ access to general practice and prescription drug dependency. 97% of practices signed up to the Weight Management Enhanced Service in 2021/22 and the service will continue for 2022/23.
Expanding primary care capacity remains a top priority, and PCNs have made excellent progress in recruiting to roles under the Additional Roles Reimbursement Scheme (ARRS). The national target is 15,500 FTEs by the end of 2021/22. Based on NHS Digital (NHSD) data and NHS England and NHS Improvement ARRS financial returns we are confident that we are on track to achieving that target, and to achieving 21,000 FTE by 31 March 2023 and 26,000 FTE by 31 March 2024.
The amount available for PCNs to recruit additional staff will increase as promised by £280 million to just over £1 billion for 2022/23. PCNs will continue to have flexibility to hire into any of 15 different roles. We continue to encourage PCNs to make full use of their ARRS entitlements, including working with mental health providers to take advantage of the doubling of Mental Health Practitioners roles to support people with complex mental health needs, that can be employed on a 50:50 shared reimbursement model. Additional flexibility to help support recruitment to these roles will also be introduced, including a broadening of the role outline to include nonclinical support for patients and an inclusion of band 4 in the eligibility.
The PCN Clinical Director funding for 2022/23 has been agreed as £0.736 per head or £44M nationally as part of the five-year deal. We confirm that this funding will be boosted by a further £43 million. PCNs will continue to be able to draw down the £1.50 per head core PCN funding, meaning that a total of £178 million will be available for PCNs and their Clinical Directors to support core running, leadership and management in 2022/23.
As agreed in the 2019 deal and subsequent updates, we will bring together, under the Network Contract DES, the two funding streams currently supporting extended access to fund a single, combined and nationally consistent access offer with updated requirements, to be delivered by PCNs. This will bring together the current £1.44 per head Network Contract DES extended hours funding and the current £6 per head CCG-commissioned extended access services. This transfer to PCNs was 4 delayed as a result of the COVID-19 pandemic and delivery will now start from October 2022, with preparatory work from April 2022.
The new enhanced access arrangements aim to remove variability across the country and improve patient understanding of the service. The new offer is based on PCNs providing bookable appointments outside core hours within the Enhanced Access period of 6.30pm-8pm weekday evenings and 9am-5pm on Saturdays, utilising the full multi-disciplinary team, and offering a range of general practice services, including ‘routine’ services such as screening, vaccinations and health checks, in line with patient preference and need. PCNs will be able to provide a proportion of Enhanced Access outside of these hours, for example early morning or on a Sunday, where this is in line with patient need locally and it is agreed with the commissioner. A summary of the new Enhanced Access requirements is included at Annex B.
NHS England and NHS Improvement has already set out in August 2021 our plans for 2022/23 for PCN service specifications and the PCN Investment and Impact Fund (IIF). There will be a limited expansion of the Cardiovascular Disease Prevention and Diagnosis service, and the Anticipatory Care and Personalised Care services will be introduced in a phased approach from April 2022.
We are now further re-phasing published plans in two ways. First, PCNs will have an additional year to implement digitally enabled personalised care and support planning for care home residents. 2022/23 will now become a preparatory year, with implementation of the requirement required by 31 March 2024. Second, there will be an extension of the period that PCNs have to develop their anticipatory care plans until December 2022. The Anticipatory Care service itself, which will be ICS led, will start in 2023/24.
The Early Cancer Diagnosis service requirements will be streamlined and refocussed in 2022/23 in response to clinicians’ feedback. The proposed new requirements are simpler and clearer, while also focusing PCNs on national diagnosis priorities arising from evidence around lower than expected referral rates for prostate cancer. The new requirements are set out in Annex C.
Three new Investment and Impact Fund (IIF) indicators focused on Direct Oral Anticoagulants (DOAC) prescribing and FIT testing for cancer referrals will be introduced in 2022/23. These changes will help to ensure that a greater number of patients with Atrial Fibrillation receive anticoagulation therapy where clinically 5 appropriate and that more patients with suspected lower gastrointestinal cancer will have their two week wait referral accompanied by a FIT test result. Funding for these indicators amounts to £34.6 million and is wholly additional to the existing £225 million funding envelope for the scheme. The detail of the three new indicators are included at Annex D along with the thresholds for two indicators previously announced.
The current five-year framework of GMS contract changes, agreed by GPC England concludes at the end of 2023/24. The default position is that the existing GMS contract will automatically roll forwards unless it is changed.
In considering options for any future potential changes to the national GMS contract, NHS England and NHS Improvement and DHSC will engage with a range of NHS organisations including the new Integrated Care Boards who will be responsible for commissioning primary care services; and patient and professional representative groups. This will be to understand views and perspectives, including the extent to which further changes to national contractual arrangements, as opposed to additional local support and commissioning, are required to support high quality and accessible general practice services, support the general practice workforce, and enable primary care to work at the heart of ICSs. Taking account of Dr Claire Fuller’s stocktake, this will include looking at how PCNs will further develop and support both practices and the wider systems in which they operate.
GPC England has explicitly ‘called on the Government to support negotiations in a refreshed fit for purpose contract agreement beyond the 5-year agreement ending in 2023/24’. NHS England and NHS Improvement confirms that it remains fully committed to discussing any proposals for potential future national changes from 2024/25 with GPC England.
Further details on the 2022/23 changes will be published ahead of April including a revised Network Contract DES Contract specification which will set out the PCN changes including the Enhanced Access arrangements.
We will separately communicate with commissioners to advise them of updates to allocations. The detail of the 2022/23 changes are set out in further detail in the annexes below.
We believe that these updates will maintain stability and limit change for general practice, while bolstering investment for the workforce and leadership, supporting our 6 communities to recover, and ensuring patients continue to receive timely, high quality care. Thank you for your hard work in supporting your populations.
Dr Ursula Montgomery (Director of Primary Care, NHS England and NHS Improvement) and Dr Nikita Kanani (Medical Director of Primary Care, NHS England and NHS Improvement)