This week the government and NHS England unveiled a package aimed at supporting general practice and improving access for patients. The deal was widely condemned by GPs and the profession's leaders.
They said the package was insufficient to tackle the problems general practice faces and that some of the proposals would increase workload and could drive more GPs to leave the profession.
So what exactly is in the package and what does it mean for practices?
The proposals promise a 'new £250m Winter Access Fund' to 'help patients with urgent care needs to get seen when they need to, on the same day, taking account of their preferences, instead of going to hospital'.
The fund can be used to pay for additional staff sessions and to expand extended hours opening. It can also be used by commissioners to expand same-day urgent care capacity in other settings in primary and community care.
The money will only be given to local systems who can 'demonstrate value' and show that they can increease the number of appointments available. ICSs are expected to submit plans for the funding by 28 October - CCGs will be expected to discuss these with LMCs as part of the process.
The plans should include steps ICSs will take to ensure all practices are achieving at least pre-pandemic activity levels. There is an expectation that the funding will be used to increase overall number of appointments delivered in general practice (this is despite the fact that practices are already delivering more than the number of appointments than before the pandemic).
NHS England says it also expects the proportion of face-to-face appointments to increase.
Practices not delivering pre-pandemic levels of funding by November or not providing sufficient face-to-face appointments will not be able to access the fund.
All practices are expected to review whether they 'have the balance right' between remote and face-to-face appointments and improve the quality of their data reporting by the end of October.
Commissioners have been asked to review appointment data and identify the 20% of practices in their area with the lowest level of face-to-face appointments, the highest number of NHS 111 calls during opening hours and with the most significant rates of A&E attendances compared with what would be expected.
This list has to be submitted to NHS England by 28 October and ICSs have been asked to take immediate steps to support improved access in these practices.
The CQC has also been asked to work with NHS England to develop an inspection model with a focus on access. The document suggests that the practices identified by ICSs could be subject to unannounced inspections by the regulator.
Contract sanctions could be applied to practices who fail to take steps to improve access or do not engage with support provided by ICSs.
A new QOF quality improvement module on access will also be introduced.
In addition, a 'real time' measure of patient reported satisfaction will be rolled out from next April. This will involve patients being sent a text message after their appointment and asked a series of questions about how they rate their access to care.
PCNs will be incentivised under the Investment and Impact Fund to improve their rates of satisfaction for 2022/23 and again in 2023/24.
NHS Digital will start to publish GP practice appointment data at individual practice level. At the moment this is only published at CCG level.
A new incentivised form of the Access Improvement Programme will support 200 more practices who are experiencing the 'greatest access challenge'. This will aim to help them, reduce the waits, increase same-day appointments and increase face-to-face care.
NHS England says it will drive forward adoption of cloud-based telephone systems as quickly as possible. The document says that this will allow more phone lines for inbound and outbound calls and also provide data on patient demand and current performance to enable practices to assess the level of support they need for dealing with calls.
The government has said it will amend legislation to allow other professionals to sign fit notes. Electronic fit notes will also be introduced to hospital IT systems from next spring to enable hospital doctors to issue notes as well.
Zero tolerance of abuse
NHS England is providing £5m to upgrade practice security measures.
The government is planning to launch a zero-tolerance campaign on abuse of NHS staff.
What do GPs leaders think of the plans?
GP leaders said they were 'dismayed' that after promising support for general practice, officials had rolled out a package that 'offers very little' - warning it showed a government 'completely out of touch with the scale of the crisis on the ground'.
The BMA said it was 'truly frightening that we have a government so ignorant to the needs of such a core part of the NHS'.
BMA GP committee chair Dr Richard Vautrey said: 'After weeks of promising an "emergency package" to rescue general practice, we’re hugely dismayed that whilst additional funding has been promised, the package as a whole offers very little and shows a government completely out of touch with the scale of the crisis on the ground.
'GPs and their teams will now be facing the worst winter for decades, and as a result, patients’ care will suffer. Appointments will be harder to book, waiting times will get longer, more of the profession could leave and GPs will struggle to cope.
'It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments; we need a more intelligent conversation about the variety of appointments and care that are available to patients to meet their needs.'
RCGP chair Professor Marshall said: 'We knew we were unlikely to get a silver bullet to solve all the challenges GPs and our teams are facing, but we hoped to see more tangible solutions to improve the care that can be delivered to patients. Our hardworking members will see this package as a missed opportunity.
'A focus purely on access ignores the other challenges we face in providing high-quality, personalised care. Crucially, there is also nothing here to address the long-standing workforce pressures facing general practice. We need the government to make good on its manifesto pledge of an additional 6,000 GPs, and 26,000 other primary care professionals, to enter the workforce by 2024.'