The delivery plan for recovering access to primary care, published on 9 May, outlines NHS England's commitments to tackling the 8am rush for GP appointments and making it easier for patients to get the help they need from primary care.
This briefing provides a summary of the key points for integrated care boards, as well as our analysis of the full plan and what it means for integrated care boards and primary care.
- The delivery plan for the recovery of primary care access builds on the GP Contract changes announced in March, setting out support for primary care to ‘tackle the 8am rush’ as well as actions for integrated care boards (ICBs), while reaffirming the commitment to embed the Fuller Stocktake’s vision for integrated primary care.
- The plan correctly diagnoses the demand and supply issues facing primary care and puts in place reasonable measures to remedy them. However, these are limited by primary care’s capacity to embed transformation, which is restricted by extraordinarily high patient demand and, with some additional funding for the plan’s measures, it will do little to alleviate staff burnout.
- The plan’s four pillars of empowering patients, implementing modern general practice access, building capacity and cutting bureaucracy are sensible, but much of their success will depend on factors outside of primary care’s control. This includes public expectations, the interface with secondary care, and future provision of the GP workforce. With the delivery section of the plan outlining actions for ICBs, as well as primary care, much of the plan’s success will depend on the ability of ICBs to oversee implementation.
- Although the plan lacks new investment for workforce over and above what is committed to the additional roles through the PCN DES, there is much to commend it. Ultimately, it is an opportunity for systems working with primary care to co-create solutions that empower 90 per cent of NHS activity.
The delivery plan has a number points relevant to ICBs, which we summarise here. The full summary of the delivery plan, including actions for primary care, is available on the Primary Care Hub App.
Improving the primary-secondary care interface
- The plan sets a target for ICBs to reduce the estimated 10 to 20 per cent of time spent by practice teams on lower-value administrative work and work generated by issues at the primary-secondary care interface.
- NHS England has asked the Academy of Medical Royal Colleges (AoMRC) to review how to reduce unnecessary work between general practice and NHS trusts.
- NHS England is asking ICB chief medical officers to establish the local mechanism, which will allow both general practice and consultant-led teams to raise local issues.
- ICBs must also address four areas, which ICBs will be expected to provide an update on to their public boards in October or November 2023:
- Onward referrals.
- Complete care (fit notes and discharge letters).
- Call and recall.
- Clear points of contact.
Delivering the plan
- Each ICB needs to take a System Level Access recovery plan to their public board in October/November 2023 and an update in February/March 2024. It will need to:
- have actions that PCNs/practices have committed to
- align to the Fuller Stocktake
- focus on immediate needs for digital telephony systems
- prioritise supporting those areas with lowest patient satisfaction scores, using GP Patient Survey data other forms of local insight.
This much anticipated delivery plan is an important step towards supporting primary care to address the challenge of demand for its services. With a focus on tackling the 8am rush through the four pillars of empowering patients, implementing ‘modern general practice access’, building capacity, and cutting bureaucracy, the plan demonstrates an understanding of the demand and supply side factors that have been limiting primary care, whilst the recognition of the sheer volume of activity that primary care undertakes – including that 30 per cent of it is not patient facing – is welcome. Further, the detail surrounding how each ambition will be delivered, the recognition of the successes of primary care networks (PCNs) and the commitment to the Fuller Stocktake vision are also welcome. Yet, with the ambition for integrated care boards (ICBs) to ‘lead the change that’s right for their system’, much will depend on ICBs’ capacity and capability to support primary care and, crucially, how they engage and co-create with primary care.
...with much of the recovery plan presenting a departure from how primary care has operated to date, success will depend on changing patient behaviour
Furthermore, with much of the recovery plan presenting a departure from how primary care has operated to date, success will depend on changing patient behaviour. We therefore welcome NHS England’s commitment to launch a major public communications campaign to explain the evolving model of primary care and how the public can best use the NHS.
Therefore, the section on delivering the plan will be critical its success. For this, ICBs are being asked to develop and present their own system-level access improvement plans to their boards, summarising the actions, commitments, offers taken up, funding and expected outcomes for practices and PCNs within their system while ensuring they align with the Fuller Stocktake’s vision of a single, system-wide approach to integrated urgent care and integrated neighbourhood teams (INTs). Although this will drive board-level ownership for the plans, it will need ongoing oversight to ensure that primary care is able and supported to deliver the plan.
...we have consistently argued for investment in primary care leadership capacity and capability to enable them to play a valuable role in systems. Considering the requirements of the plan, this is now imperative
Through engagement with our primary care network members, ICB directors of primary care and primary care partners, we have seen a real commitment to system working, but in practice this has been hindered by capacity issues on both sides. For primary care, we have consistently argued for investment in primary care leadership capacity and capability to enable them to play a valuable role in systems. Considering the requirements of the plan, this is now imperative. And with place partnership boards now developing, there is a further opportunity to involve and co-create with primary. As these develop, we hope that primary care is engaged with as an equal partner.
Although the four pillars correctly identify the demand and supply challenges facing primary care, without significant additional investment into general practice and PCNs and more GP capacity there will be a limit as to how far the ambitions can be achieved. The focus on empowering patients, particularly the expanded role of community pharmacy, is an important step towards making best use of the full breadth of primary care, while the measures to expand multi-disciplinary teams (MDT), recruit and return GPs to the workforce, and move doctors from elsewhere in the system are all welcome, they are do not provide an immediate solution to the issue of a lack of GPs. Much will rest on how primary care and community pharmacy will be empowered and enabled to work together, as well as how MDTs and doctors from elsewhere in the system will be trained and supervised. The provision of support in these areas, as well as the expectation that a portion of the system development fund (SDF) will be allocated to primary care are welcome, yet this will still require oversight and leadership from an already stretched GP workforce, where leaders are contending with clinical shifts, the transition to system working, and extremely high patient demand.
the commitment to cut bureaucracy is another welcome addition to the plan
This is also true of the actions around implementing modern general practice, which will require significant leadership capacity and capability. From those in our primary care network membership that have implemented some of these changes already, we have heard that these transformation projects need sufficient time and headspace as well as strong and ongoing engagement with patients and the public on new models of care. This is why the commitment to cut bureaucracy is another welcome addition to the plan, placing the onus on ICBs to address the four key areas of onward referrals, complete care, call and recall, and clear points of contact while ICB chief medical officers are to establish the local mechanism that allows both general practice and consultant-led teams to raise issues locally. This is complemented by the Bureaucracy Busting Concordat and the drive to reduce medical evidence requests and to increase self-certification, all of which are welcome.
The recovery plan correctly diagnoses the issues facing primary care and does put in place reasonable measures to address them. However, the factors that will decide the plan’s success lie, for the most part, outside of primary care’s control. Whether this be ICBs’ own access improvement plans or their measures to cut bureaucracy, the GP pipeline or simply the time it will take for patients to adapt to the modern way of accessing general practice, these are all outside of primary care’s gift. With many actions placed on ICBs, this is an opportunity for them to continue to work with primary care to co-create solutions that work for their patients. Primary care is the front door of the NHS, managing approximately 90 per cent of all NHS activity, and it is vital that systems support, empower and enable primary care, as well as deliver against their own actions in this plan.
Key actions for members
- PCNs must submit Access Improvement Plans to ICBs by the end of June 2023.
- Cloud-based telephony must be in place for all practices by the end of 2025.
- ICBs must develop and present a System Level Access recovery plan to their public board in October/November 2023 and an update February/March 2024. It will need to:
- have actions PCNs/practices have committed to
- align to the Fuller Stocktake
- focus on immediate needs for digital telephony systems
- prioritise supporting those areas with lowest patient satisfaction scores, using GP Patient Survey data and other forms of local insight.
How we are supporting members
- Through our design groups we are supporting primary care and ICBs with implementation of the GP Contract changes and recovery plan, as well as the Fuller Stocktake recommendations.
- Through our ICB forums for directors of primary care and primary care partners, we are working to ensure that ICBs feel supported and can share knowledge, skills and experience in how they are supporting primary care and ensuring ICBs continue to have a strong focus on primary care.