Summary of Access Contract Changes 23/24

The 23/24 GP Contract, QoF and IIF schemes focus on practice’s improving access for patients. To clarify what is expected, guidance on each scheme is given below:

GP Contract:

On 6^th March 2023, NHS England declared its intention to impose contractual changes onto practices. These changes are include in the letter NHS England » Changes to the GP Contract in 2023/24.

The specific regulatory changes relating to Access were laid before parliament on 18^th April and due to come into force on 15^th May.

We strongly recommend the BMA guidance on interpreting these changes is considered GP access: meeting the reasonable needs of patients (bma.org.uk).

The LMC summary is:

• Both the BMA and the LMC believe this should be implemented in line with the BMA Safe Working Guidance.
• The purpose of the new requirement is to stop practices from asking patients to call back another time/the next day to make an appointment. Instead, when practices have reached safe clinical limits they can signpost patients to other appropriate clinical settings. For example: 111; UTC, Urgent Mental Health Helpline; and the Community Pharmacy Consultation Service (CPCS).
• The contract does not stipulate the timeframe in which a further assessment or appointment is to be offered. It states the further assessment should take place, “at a time which is appropriate and reasonable having regard to all the circumstances”. The target to have seen patients within 14 days is within QOF and IIF. Some practices will be able to achieve this, but if practices cannot, this is not a breach of the contract. Although it will have some impact on QOF income.
• It is important that the system develops escalation routes for practices that have reached safe capacity. Practices should ensure that they reflect pressures in their GPAS weekly submissions to enable the LMC to focus system partners on developing escalation plans that enable safe onward signposting of patients.

IIF

In 23/24, IIF has been simplified so that 70% of funding will be paid to practice on a monthly basis. The remaining 30% will be paid on delivery of a Capacity, Access and Improvement Plan based on 3 areas:

1. patient experience of contact;
2. ease of access and demand management; and
3. accuracy of recording in appointment books

The Kent & Medway ICB bulletin of 20^th April General practice update 20 April 2023 (mailchi.mp) contains a link to a survey to be submitted to the ICB by 5^th May for agreement with the ICB by 12^th May. A subsequent email sent to PCNs on Friday 21^st April, clarifies the survey responses are optional, with only the plan for each being mandatory.

The Capacity and Access guidance can be found at PRN00157-ncdes-capacity-and-access-payment-2023-24-guidance.pdf (england.nhs.uk).

Please note page 2, point 5:

‘ICBs, PCNs and member practices should co-develop and co-own a local improvement plan setting out the changes they intend to make. Local improvement plans should address any identified barriers to improvement or wider support required and link to local support offers for integrated primary care, and where commissioner support is required, commissioners should commit to providing that support. The funding provided through the National Capacity and Access Support and Improvement Payment can be used by PCNs to take forward development and delivery of their local improvement plan’

Therefore, when creating their outline plans, we suggest that PCN’s consider what support they require from the ICB to be able to deliver those plans, whether that be to maintain or increase access, or to deliver access to patients through other means (ie UTCs, Same Day Hubs, secondary care interface), or the integration of community staff with PCNs.

The ICB will be holding a webinar on Thursday 27^th April at 12pm to discuss suggestions for plans and provide further information.

The LMC summary is:

1. Patient experience of contact is based on FFT feedback and the GP patient Survey. Practices need to ensure they enable practices to submit FFT feedback after an appointment and to submit monthly via CQRS. Plans should reflect the specified 5 questions from the practice’s GP survey results and how scores can be maintained or improved.

2. Ease of access and demand management is based on practices either having or migrating to cloud based telephony (CBT) and utilising reporting functions to understand and manage demand and enabling online consultations in core hours.

3. Accuracy of appointment books. Practices are strongly encouraged to read the guidance to understand the 8 appointment slot types that will be reported on to identify if a patient has been booked an appointments with 14 days. Not all slot types will be reported on for these purposes so thinking carefully about how appointments will be mapped is critical.

QoF Access

The 23/24 Qof Framework can be found at NHS England » Quality and Outcomes Framework guidance for 2023/24 and include a Quality Improvement module on Optimising Access to General Practice.

Practices objectives of the QI module are to:

• Understanding data in relation to practice demand and capacity.
• Raising understanding of quality improvement techniques
• Making changes that enable more effective use of capacity and therefore better meet demand (e.g. reducing the number of avoidable appointments)
• Improving staff well-being
• Improving patient experience

The exercise is carried out at practice level and verification is through submission of the template included in the QoF framework, with practices required to self-declare that they have attended a minimum of two PCN peer review meetings (either in person, where appropriate, or virtually).