NHS England has published the new GP access recovery plan, with a focus to develop a sustainable general practice, improve digital access and tools, support citizen remote care, build capacity and expand supporting services such as community pharmacies.
The blueprint “sets out actions to improve access to care, better support patients to manage their own health, and to modernise general practice for future generations.”
The plan is split into a number of key sections, with related ambitions and planned actions. Those sections are empowering patients; implementing modern general practice access; building capacity; and cutting bureaucracy. The document also includes details on the delivery of the overall plan and aims around the future of primary care.
The main aims here include improving information and NHS App functionality, increasing self-directed care and expanding community pharmacy services.
With regards to the App, the plan notes that NHS is currently working to provide more public access to four existing functions: to view prospective clinical records, to order repeat prescriptions, to see messages from their practice as an alternative to text messaging, and to manage routine appointments.
The 2023/24 contract asks all practices to enable prospective record access for patients by November 2023, the plan highlights; it adds that NHS recently published guidance on directly bookable appointments and states that practices should make online booking of such appointments available for reasons such as smear tests, B12 infections or vaccination clinics.
Moving onto how NHSE will help to deliver increased levels of self-directed care, the document notes that more than 30,000 people self-refer each month, and the 2023/24 operational guidance “asks systems to expand this for certain carefully considered community-based services from September 2023.” These services include selected community musculoskeletal services, audiology for older people, weight management services, community podiatry and wheelchair and community equipment services. The plan states that up to 50 percent of people could be self-referring by March 2024, with NHS to monitor this to ensure that self-referral pathways to not lead to inappropriate demand.
Highlighting how home monitoring “can substantially improve health outcomes and reduce the need for regular and urgent appointments”, the plan says that NHSE is funding digital tools for patients to send their readings to their practice.
On the expansion of community services, the document describes the planned launch of Pharmacy First, a new service which will enable pharmacists to supply prescription-only medicines. As part of this, and tied into the new funding for the service, NHSE will “invest to significantly improve the digital infrastructure between general practice and community pharmacy”. This will include working with community pharmacy suppliers and general practice IT suppliers to develop and deliver interoperable digital solutions, capable of streamlining referrals, providing additional access to relevant clinical information from the GP record, and sharing structured and timely updates following a pharmacy consultation back into the GP patient record.
Implementing modern general practice access
The ambitions here revolve around delivering better digital telephony, simpler online requests and faster navigation, assessment and response.
With regards to the first, the plan states: “NHS England will support the transition to digital telephony for practices that commit by 1 July 2023 to the move, including procurement, contract negotiation and financial support for new equipment, transition costs and training.” The ambition is to transition at least 1,000 practices before the end of 2023, and expect to transition all other practices who sign up by the end of March 2024. It adds that the 2023/24 GP contract requires all practices to use the nationally-set Cloud (digital) Telephony Framework for procuring digital telephony, which lists suppliers capable of providing the functionality needed to support high-quality patient access.
“It is also important for practices, PCNs, places and systems to have in mind the strategic direction described in the Fuller Stocktake,” the document adds, drawing attention to the shared action “to develop a single system-wide approach to managing integrated urgent care… NHS England recommends PCNs use the same provider, and ICBs may want places or whole systems to do so.”
Moving on to look at simpler online requests, the plan states that NHSE wants to make online requests “easy and dependable”. It acknowledges that the contractual requirement to provide online access was introduced during the pandemic, and that the pace demanded by the pandemic led to many practices struggling to find the time to fully assess the products on offer, or to fully implement systems.
“NHS England will make high-quality online consultation, messaging and booking tools available to general practice, alongside guidance on the relative strengths of the tools in different areas by July 2023,” the plan states. 54 ICBs are to work with PCNs and practices to decide which tools best enable them in shifting to the Modern General Practice Access model.
NHSE will also encourage implementation of the What Good Looks Like Guidance by providing ICBs with a “simple tool to help them review sites, identify best practice examples in their systems, and target areas for improvements.”
The final ambition in this section centres around building faster navigation, assessment and response capability; here, NHSE states that it will “fund higher-quality digital tools that enable the shift to online and support the combined workflow for all requests, for the whole practice team to contribute to rapid assessment and response.”
The plan lists ambitions around developing larger multidisciplinary teams, recruiting more new doctors, improving retention and return of experienced GPs, and ensuring higher priority for primary care in housing developments.
As part of the aim to build larger multidisciplinary teams, NHSE states that up to £385 million will be made available in ARRS funding to continue to grow capacity and expand roles. These roles will include a digital and transformation lead, who will focus on helping practices move to using new digital tools and supporting the Modern General Practice Approach.
In addition, the plan notes that all primary care staff will have access to the ‘Looking After You’ suite of accessible health and wellbeing offers (which includes virtual support for patients), and the Practitioner Health Service has also recently been extended to provide a free, confidential mental health and addition service.
Training around care navigation and digital transformation is to be launched by NHSE, to assist with the upskilling of newer roles in general practice.
Here, the plan emphasises the need to improve the primary-secondary care interface. As part of this, the document says that trusts should ensure that upon discharge, or after an outpatient appointment, patients receive everything they need rather than leaving patients to return prematurely to their practice. By 30 November 2023, “providers of NHS-funded secondary care services should have implemented the capability to issue a fit note electronically,” the plan sates. “From December this means hospital staff will more easily be able to issue patients with a fit note by text or email alongside other discharge papers, further preventing unnecessary return appointments.”
Ensuring that clear points of contact are available is also key. The plan notes that ICBs should ensure that providers establish single routes for general practice and secondary teams to communicate rapidly, such a single outpatient department email for GP practices or primary care liaison officers in secondary care.
ICBs will be expected to provide an update on this area to their public board in October or November this year.
The plan also emphasises the need to “reduce the demands on practice time from unnecessary or low-value asks and improve processes for only the most important requests for medical evidence that remain”. The delivery actions in this area include ongoing work to reduce the burden on GPs with regards to verifying health information and providing medical evidence, including the digitisation of fit notes.
Delivering the plan
The document highlights that ICBs will be expected to develop their own system-level access improvement plan, which is to include a summation of the actions that their PCNs and practices have committed to, including confirmation of funding and offers that each PCN or practice wants to take up.
“An immediate critical enabler is to ensure digital telephony systems can support the future direction of PCNs and places in offering a single system-wide approach to integrated urgent care and integrated neighbourhood teams,” it states.
From May 2023, NHSE is to introduce a National General Practice Improvement Programme; this will include three tiers of support to help general practice deliver change. The document emphasises that these offers will be underpinned by a set of principles to ensure that change is clinically-led, data-driven, evidence-based and measurable.
The first tier, open to all, will see NHSE build communities of practice and run a series of webinars on each of the key areas covered in this plan. “We will look at how those who have implemented change can share their experiences, including planning around demand and capacity, and for companies providing digital telephony and tools to showcase their offers,” NHSE states.
The existing ‘Accelerate’ programme will be adapted into the second a third tiers to help practices in “the most challenging circumstances or those that simply feel they do not have the capacity or bandwidth to plan a path towards a Modern General Practice Access approach.”
The plan continues: “Of these two offers over the next two years, up to six months of support will be provided for up to 1,500 practices, which will be selected based on need and ICB nomination. An intermediate option will provide up to three months of support to 800 practices and 160 PCNs.” Both options are to involve hands-on support, a data diagnostic and tailored analysis of capacity and demand, with NHSE to facilitate courses for systems to help build their transformation capability.
Choice and equity of access
Here, NHSE draw attention to the fact that their ambitions will “make it easier for everyone to contact their practice in the way that they prefer”.
This is why the plan avoid calling out specific cohorts of patients as much as possible, it clarifies; it emphasises that primary care services must “reflect the needs of diverse groups of people” and “patients will always have the option of visiting their practice in person”.
As part of efforts to make it easier to join a new practice, NHSE has simplified the forms and created “an easy-to-use online registration service that is also available on the NHS App”.
Communicating with the public
“We want to make navigation clearer for patients,” NHSE states.
The plan commits to a national campaign with three main components, designed to increase public understanding of the changes to services, the benefits and how to access the services. One of the components is digital access, with a focus on building knowledge and confidence in use of the NHS App, and the digital access routes to general practice. The other components include developing knowledge of the wider practice team, and the wider care available, including when, why and how to access self-care advice, 111 online and other services.
To explore the plan in full, please click here.