Classification: Official
Publication reference: PRN01226

To:

• Integrated care boards:
  • chief executive officers
  • chief operating officers
  • digital directors
  • heads of primary care
  • heads of commissioning
  • GP medical leaders

cc:

• NHS England regions:
  • regional directors
  • regional directors of commissioning
  • regional directors of primary care
  • digital directors
  • primary care medical directors

Dear colleagues,

Delivery plan for recovering access to primary care: update and actions for 2024/25

The NHS is determined to make it easier and quicker for patients to see their GP and members of the primary care team.

That is why in May 2023, along with the Department of Health and Social Care (DHSC), we published a two-year delivery plan for recovering access to primary care while taking pressure off general practice.

Since the plan’s publication, we have delivered:

• Record numbers of general practice (GP) appointments with more than 360 million appointments – excluding those for Covid vaccinations – delivered in the 12 months up to February 2024, an additional 57.5 million appointments than before the pandemic (Pressure on NHS services remains high – NHS England). This includes 3 in 5 GP appointments delivered face-to-face, over half booked and attended on the same day or next day, and nearly 9 in 10 appointments attended within two weeks of booking (for appointments not usually booked in advance).
• The biggest expansion of services in pharmacy for years – making it easier for patients to access treatment for common conditions through their local pharmacy
• More than 36,000 additional direct patient care roles now compared to 2019 (Appointments in General Practice, September 2023 – NHS England Digital, Expanded NHS support available for patients in GP practices across the country – NHS England)
• 90% of practices enabling patients to use the NHS App to send messages, book appointments and order repeat prescriptions

The fact that these achievements, and others (as set out in Annex 2) have been achieved against the backdrop of sustained, significant demand on primary care, is testament to everyone’s commitment to providing high-quality care. 

But we need to go further.

So, continuing to improve timely access to primary care is an NHS priority and a core part of recovery in the NHS planning guidance for 2024/25.

The second year of the delivery plan for recovering access to primary care is about realising the benefits to patients and staff from the foundations we have built since launch in the following four priority areas.

Empowering patients

We’ll continue to break down the barriers patients face and make it easier for them to access care, while taking pressure off general practice.

The number of patients viewing their records on the NHS App will increase from 9.9 million to 15 million a month, and the number of patients using the NHS App to order repeat prescriptions will increase from 2.7 million to 3.5 million per month, by March 2025.

It will be become more common for patients to self-refer, with the number of self-referrals across all pathways increasing by a further 15,000 patients a month by the end of March 2025.

And we will continue to realise the potential of community pharmacies, growing the monthly patient volumes across all three pharmacy services by March 2025 by at least 71,000 blood pressure check consultations; 25,800 oral contraception consultations; and 320,000 Pharmacy First clinical pathways consultations.

Implementing Modern General Practice Access

Over the next year, we will support practices to make full use of digital telephony capabilities, including callback functionality and ensuring that practices meet capacity and access improvement payment (CAIP) payment criteria. This will include implementing a single view of all requests whether online, phone or walk-in through the use of digital tools, each of which includes structured data to support the assessment and streaming to the appropriate response.

And we will begin to share data on the number of calls to 111 in core hours with primary care networks (PCN) clinical directors, to support quality improvement, so practices only divert to 111 in exceptional circumstances.

For 2024/25 we will strengthen locally owned delivery of transformation support, alongside continuing to provide funding and national support through the General Practice Improvement Programme. 

Build capacity

The NHS needs more GPs. That’s why in the NHS Long Term Workforce Plan (LTWP), the NHS and Government pledged to increase the number of GP training places by 50% to 6,000 by 2031/32.

This year we will take another step towards meeting that ambition and, through the LTWP, will focus on growing GP specialty training by 500 places in 2025/26, timed so that more of these newly qualifying doctors can train in primary care.

Cut bureaucracy

We want GPs and their teams to spend more time treating patients and less time managing paperwork.

That’s why this year we have already changed the GP contract to suspend and income protect 32 out of the 76 Quality and Outcomes Framework (QOF) indicators.

A new online patient registration service will be expanded to all practices by 31 December 2024 saving time for patients and practices.

Improving the primary-secondary interface will be a key focus in 2024/25 and we are looking for significant progress on implementation, recognising the benefits for patients and staff including in general practice.

Next steps

The detailed actions for 2024/25 are included in Annex 1. with an update on delivery of Year 1 actions in Annex 2.

Funding for 2024/25 is set out in Annex 3, with more details given in the recent letter to the profession on the 2024/25 general practice contract.

We are asking integrated care boards (ICBs) to continue to report progress against all the elements of the delivery plan in their October or November 2024 public boards.

We will issue further guidance, but this report should outline the local plans to improve access, progress against the primary and secondary care interface, and include:

• a breakdown of the use of the funding streams for primary care in 2023/24
• projected use in 2024/25, including for service development funding (SDF) for high quality online consultation software and transformation funding
• an update on how many PCNs have claimed the 30% CAIP payments

In the meantime, please contact your regional NHS England representative or england.pccsdeliveryunit@nhs.net if you have any questions.

Thank you for your continued support and hard work in improving our services for patients.

We look forward to continuing to work with you and building on the achievements made in the first year of the delivery plan.

Yours sincerely,

Dr Amanda Doyle OBE MRCGP, National Director for Primary Care and Community Services, NHS England.

Dr Claire Fuller MBBS DRCOG MRCGP, National Medical Director for Primary Care, NHS England.

Annex 1: The NHS delivery plan for recovering access to primary care 2024/25

A. Empowering patients

NHS App and digital access

Latest data shows 84.1% of practices have enabled patients to view prospective records compared to around 21% in May 2023 and feedback from patient groups is positive (for more details on access see: NHS England » Millions more people given access to their GP records online).

In addition, 94.3% of practices offer patients the ability to book/cancel some specific appointments online and 98.9% offer patients the ability to order online repeat prescriptions, although we estimate only 2.7 million (around 11%) of repeat prescriptions per month are ordered this way.

Our 2 goals for 2024/25 are firstly, to encourage more patients to use the online repeat prescription function; and secondly, to increase patient use of their digital health record, resolving any outstanding issues with any practice that has not enabled access to prospective records for their patients (prospective record access from 31 October 2023 is a GMS contractual requirement).

We are setting ourselves the goal of increasing the number of patients using the NHS App or online channels to order repeat prescriptions to 3.5 million per month. We will be sharing repeat prescription data with primary care networks (PCNs) and will be working with practices and patient groups to understand how we can help overcome any barriers to adoption.

We have been asked how offering patients the ability to book specific appointments online fits with Modern General Practice Access where all requests are assessed around the need for a face-to-face appointment.

Appointments available for patients to book directly online are for regular routine appointments that do not require prior assessment, such as booking for a regular B12 injection or where a practice has assessed the patient’s needs and identified the right type of appointment can be offered (for example, with a specific healthcare professional or as part of a particular clinic).

As software improves, many practices are also now texting patients a link so they can choose and book an appointment online after the assessment of their request determines an appointment is required. Both approaches can reduce pressure on administrative staff and improve flexibility and experience for patients.

Expanding self-referral

By March 2024, we are on track to increase by 50% the number of people self-referring to the 7 community services prioritised where general practice involvement may not be necessary – an additional 15,000 patients a month.

However, there remains variation across integrated care boards (ICBs), pathways and providers; and therefore opportunity exists for more people to benefit from self-referral in these services, as well as others where self-referral may be clinically appropriate.

Our goal for 2024/25 is to further increase self-referrals across all pathways by at least a further 15,000 patients a month by the end of March 2025, by working with ICBs to reduce variation and ensuring healthcare staff and patients can readily understand availability of self-referral locally.

Expansion of pharmacy services

In 2023/24 we have successfully expanded the existing blood pressure and oral contraception services and launched Pharmacy First, where pharmacists can now supply some prescription-only medicines where clinically appropriate to treat 7 common health conditions.

We have been asked how Pharmacy First reduces practice workload if practices still need to review pharmacy actions as part of approving the patient record update. It is important that practices are updated on the outcome of any consultations that take place elsewhere in primary care to inform later clinical decision-making. The GP is also the data controller for the patient record.

We have delivered a range of digital enhancements that make it easier for pharmacists and practice staff to capture outcomes from these new clinical pathways. Pharmacy systems now capture complete, structured data linked to the patient.

Over the coming months, this data will start to be surfaced directly into practice workflows. This means practice staff will no longer have to match records to patients, manually code or transcribe from emails.

Instead, they will be able to review consultation information, including notes and details of medications issued, and add the data to the patient record with one click. Designed with GPs and practice staff, this is a significant enhancement to existing processes, and will provide a template for improving post consultation messages from other care settings.

Our goals for 2024/25 are to grow the monthly patient volumes across all 3 pharmacy services by March 2025 by at least 71,000 blood pressure check consultations; 25,800 oral contraception consultations; and 320,000 Pharmacy First clinical pathways consultations. We will review the ambition of this trajectory in September, when public uptake of the service in the first 9 months is understood. We will continue to monitor uptake by Distance Selling Pharmacies, which have an important role to play in providing wider access to patients via video consultations.

Greater flexibility

Recognising pharmacists and pharmacy technicians each have expertise in medicines, DHSC has taken forward commitments in the delivery plan to release pharmacists’ time for more patient-facing services including:

• consultations on enabling the use of patient group directions by pharmacy technicians and modernising pharmacy legislation on pharmacy supervision
• amending legislation to increase dispensing efficiency

The Medicines and Healthcare products Regulatory Agency (MHRA) has reclassified eligible medicines, so they are more easily available to patients in pharmacies, and elsewhere, without requiring an appointment and prescription. In 2024/25, DHSC will continue to work with stakeholders and partners to support and progress these commitments further.

B. Implementing Modern General Practice Access

Better digital telephony

The delivery plan set out the key elements of a Modern General Practice Access Model starting with digital telephony. All bar a small number of practices are already, or soon will be, operating digital telephony – over 99% of practices have signed the necessary contractual arrangements.  

An increase from 55% of practices in an October 2022 audit and around 70% in May 2023 (for some, their telephony supplier has moved installation dates into April/May 2024 due to capacity constraint reasons. We currently expect 99% of practices to be live  by May 2024).

Our goals for 2024/25 are to encourage the full use of digital telephony capabilities, including callback functionality, and for PCNs to review the key telephony metrics across their practices (including number of calls, average wait, abandonment time, average call length) to support quality improvement in demand management and planning of care navigation.

Separately, we plan to share data on the number of calls to 111 in core hours with PCN clinical directors to support quality improvement. Practices should only divert to 111 in exceptional circumstances and should inform their local commissioner (ICB primary care team).

Simpler online requests

The second component aims to make digital communications and access easier for those patients who can use and prefer these channels. The functionality of existing and new digital tools has continued to improve over the last year, and this is set to continue next year. We expect digital channels to be available to patients as a minimum during core hours ensuring parity across phone, walk-in and digital access.

Practices who have focused on this are receiving more requests online and are able to easily ask clarifying questions to patients. This supports effective assessment of need and care navigation, supports practices to determine the right next steps and (where functionality is installed) to send a link for patients to self-book an appropriate appointment if required. This also frees up phone lines for patients who need them.

To support practices to access high quality online consultation, messaging and booking tools, we have raised the standards and minimum functionality that we expect suppliers of these key tools to be able to meet. This will form part of future digital frameworks and further detail on the ‘digital pathway framework’ to support general practice will follow in due course.

However, many existing suppliers are already introducing enhancements to their products based on these higher standards. ICBs will be funded to support practices to secure the high-quality tools they need (see Annex 3 for more details).

Our aim for 2024/25 is to increase the use of these higher quality digital tools and we will be tracking and reporting on the number of patients using digital access throughout the year.

Faster care navigation, assessment and response

The third component aims to ensure every patient knows on the day how their request will be handled. The delivery plan described the role of care navigation to self-care and other primary care services, and we have made care navigation training available for every practice in England. To date, over 6,100 staff have registered and over 3,375 have completed the training available in 2023/24.

In 2024/25, using the digital tools and funding outlined in this letter, we want to support practices to implement a single view of all requests whether online, phone or walk-in, each of which includes structured data to support the assessment and streaming to the appropriate response.

This means general practice staff do need to collect key data from patients who phone or walk-in. Practices which do this well use a team approach to streaming, often led by an experienced GP.

Transformation support

Over the last 9 months, more than 1,650 practices have benefited from the national general practice improvement programme (GPIP), with over two-thirds of these practices benefiting from ‘hands on’ support. With GPIP support, practices have seen reduced call wait times, fewer abandoned calls, and significantly increased use of digital access routes by patients, while also reducing avoidable appointments (phase A practice-level GPIP support). The programme has grown the national primary care improvement community to over 12,000 members.

Our goal for 2024/25 is to scale the learning from GPIP and strengthen locally owned delivery of transformation support in partnership with ICBs. This approach will enhance the critical role of systems and enable those closest to local challenges to lead engagement, and to shape, target and deliver support.

NHS England will continue to provide an online support offer making this knowledge and best practice available to all alongside flexible, hands-on support to a proportion of practices identified as most benefitting by their ICB, as part of the transition to a system-owned delivery model.

Funding for Modern General Practice Access

For 2024/25 we are making 3 funding sources available to support practices implement what we know is a major transformation. First, through support for high quality online software (for example, online consultation tools, messaging systems and appointment booking tools) (see Annex 3).

Second, we will continue to provide a one-off transformation fund (an average of £13,500 per practice) to any practice that has not already claimed this to cover the additional resource needed to make the switch from an appointment book approach to Modern General Practice Access.

Third, in the 2024/25 contract we are continuing to income protect most investment and impact fund (IIF) indicators to create a capacity and access payment (CAP) of £292 million to support implementation. This is covered in paragraphs 28 – 31 in the contract letter.

As in 2023/24, 70% of funding will be paid to PCNs without any conditions, with the remaining 30% available to PCNs once all practices within a network have put in place the components of the Modern General Practice Access Model, which each attract a third of the overall capacity and access improvement payment (CAIP) funding.

This funding will be available from confirmation, so practices who have already implemented all 3 elements should confirm this with their ICBs from April 2024, and will receive monthly funding thereafter.

C. Build capacity

Empowering patients and improving Modern General Practice Access will make a significant contribution, but the increased level of demand on primary care needs to be underpinned by more investment in the primary care workforce as set out in the Long Term Workforce Plan (LTWP).

The delivery plan focused on delivering the manifesto commitment of over 26,000 more direct patient care staff and 50 million more appointments by March 2024. Latest data shows we have delivered both and exceeded staff roles, with over 36,000 additional direct patient care roles now compared to 2019 (Appointments in General Practice, September 2023 – NHS England Digital, Expanded NHS support available for patients in GP practices across the country – NHS England) meaning an expanded team of health professionals are now available to help patients get the right care when they need it, in addition to seeing their GP or practice nurse.

Our goals for 2024/25 are to support the achievement of the LTWP ambitions. This includes initially growing GP specialty training by 500 places in 2025/26, timed so that more of these newly qualifying doctors can train in primary care. Further expansion of GP specialty training places will then take place with 1,000 additional places (5,000 in total) in 2027/28 and 2028/29.

Planning policy

As described in the plan, DHSC will continue to work with the Department for Levelling Up, Housing and Communities (DLUHC) on how reforms to planning policy could better support funding of primary care estate, including new areas of housing development.

D. Cutting bureaucracy

Primary-secondary care interface

The delivery plan asked ICB chief medical officers (CMOs) to focus on and report their progress against 4 main recommendations on how to improve the interface from the Academy of Medical Royal Colleges (AoMRC) report, including:

• onward referrals
• complete care (fit notes and discharge letters)
• call and recall
• a point of contact for clinicians

The importance of these commitments are reinforced by the RCGP interface guidance and we suggest systems work through producing their local version of the guidance. Good progress has been made in some local areas, but there remains more to do in all systems.

Our goal for 2024/25 is provide more support to ICB CMOs with national leadership co-led by the NHS England national medical directors for primary and secondary care. We have already asked ICBs to report progress through their public board in April or May and will again ask ICBs to do this in October or November 2024. This will be a focus for 2024/25 and we are looking for significant progress on implementation, recognising the benefits for patients and staff alike.

In 2023/24 we developed an assessment tool at the request of many ICBs. In 2024/25 we are asking all ICBs to use this across their secondary care NHS providers, to baseline, improve and report on progress as they implement the AoMRC recommendations and RCGP interface guidance. Themes from the assessment tool will inform future support and guidance including content for October or November board reports.

Progress in this area is dependent on this being a joint endeavour between secondary care and primary care, and we are expecting all trusts to have identified a lead clinician for this important area of work.

Roll out of easy-to-use online registration

Conventional patient registration processes can be complex and resource intensive for practices and patients with around 6.8 million processed annually. A new online patient registration service and paper form has been co-developed and tested with relevant groups including general practice staff.

The commitment for 2,000 practices to be using this service was met in November 2023, one month ahead of schedule. More than 1 million patients have used a national online service to register with a GP since its launch 18 months ago. In 2024/25, we will roll this out to all practices by 31 December 2024.

Building on the Bureaucracy Busting Concordat

DHSC has worked with other government departments to reduce unnecessary bureaucracy and administrative burdens placed upon general practice and free up time for patients. In 2024/25, DHSC will seek to reduce bureaucracy building on ongoing work taking place across government. 

NHS delivery actions for 2024/25

Annex 2: Update on delivery actions for 2023/24

Annex 3: 2024/25 funding streams

Further funding will be available to in 2024/25 to support the continued delivery of the delivery plan for recovering access to primary care including

• transition cover and transformation support
• General Practice Improvement Programme (GPIP)
• support the uptake of digital tools through digital pathways (DP framework)
• funding to support the continued roll-out of Pharmacy First

Confirmation of allocations (where applicable) and further detail of funding flows will follow as soon as possible.

In addition, there a number of funding streams which are available to PCNs and which support their role in primary care transformation:

Maximum network funding available (per Ready Reckoner)