Primary care access improvement plans – briefing note for system-level plans

1. Introduction

Following the publication of the Delivery plan for recovering access to primary care in May 2023, integrated care boards (ICBs) are required to develop system-level access improvement plans. This aligns with their leadership responsibilities and accountability for commissioning general practice services and delivery as well as, from April 2023, community pharmacy, dental and optometry services.

2. Considerations for development of plans

It is expected that regions will play a key role in supporting ICBs in the development of plans. The prompts below will help regions and ICBs in this process and ensure that plans include the required actions and considerations. It is acknowledged that plans may need to iterate over time, particularly as take-up of support offers and digital tools are confirmed. ICBs are not required to use a national template for plans.

Vision and improvement approach

  • Is there a clear vision that aligns with the ambitions of the Delivery plan for recovering access to primary care?
  • Is there alignment with other system plans?
  • Have interdependencies been considered to maximise system benefit e.g., UEC?
  • Has the ICB considered the five components of NHS IMPACT and a plan for systematically embedding an approach to continuous improvement?
  • Does the ICB have a named SRO for delivery?

Supporting information

Health inequalities

  • How does the plan support equality, diversity, and inclusion?
  • How does the ICB intend to support practices in areas of deprivation and practices disproportionally affected by health inequalities?
  • Has an Equalities and Health Inequalities Impact Assessment (EHIA) been developed?

PCN/practice actions

  • Does the ICB plan include an overview of PCN/practice plans?
  • Does it include the following?
  • Assurance that all required actions have been included in plans?
  • Delivery confidence for all aspects of the recovery plan
    • empower patients;
    • implement modern general practice
    • build capacity;
    • cut bureaucracy
  • Take-up of support and training offers?
  • Key challenges, risks and mitigations?

Supporting information

Integrated care board (ICB) actions

  • Do plans incorporate all ICB actions from the delivery plan checklist?
  • Do plans set out the ICB’s delivery approach for all aspects of the delivery plan for recovering access to primary care
    • empower patients;
    • implement modern general practice
    • build capacity;
    • cut bureaucracy?
  • Has the ICB set out actions to improve the primary-secondary care interface, including on the four key areas set out in the recovery plan with clear leadership responsibility in the ICB Board?
  • Do systems have a plan to support signup and implementation of the pharmacy Common Conditions Service, including reviewing of existing locally commissioned services to ensure strategic fit?
  • Have local antimicrobial resistance (AMR) processes been reviewed?
  • Have scaling opportunities and a coordinated approach to procurement been considered for digital?
  • Has the business change required been considered for implementation of digital tools?
  • Has the Support Level Framework been used with practice and PCNs to identify support needs?
  • What local support is being provided/funded?
  • How is the ICB leveraging and ensuring maximum uptake of national transformation support and training offers, including ensuring participation from PCN/practices that need support the most?
  • Has the ICB set out plans to support and build their workforce, including supporting PCNs to use their full ARRS budget, delivering GP retention schemes and promoting national health and wellbeing offers?
  • How is the ICB building improvement capability and capacity within and across their system, including sharing learning across the system?

Supporting information

The Support Level Framework has been shared with regions

Assuring delivery

  • Are there clear, quantified improvement trajectories?
  • Are there clear delivery milestones?
  • Does the plan set out how ICBs will monitor and track delivery against trajectories and milestones?
  • What are the mechanisms to collect, analyse and share data?
  • Is the ICB confident that the plans will make a difference and patients will know the plans are working?
  • Does the plan give the overview of progress to date?

Supporting information


  • Is there a clear plan for how national funding will be used and maximised?
  • How will the ICB track and report on spend and ensure funding is spent in-year?
  • Has the ICB considered how other funding could be aligned?
  • How will the ICB ensure PCNs/practices are receiving funding and resource in a timely way to support delivery and transition?
  • Is the ICB assured that primary care recovery funding is being used for its intended purpose and as additional support for primary care, with other primary care funding, e.g., GP IT remaining in place?

Supporting information


  • Has the ICB put in place a robust communications delivery plan that focuses on promoting key delivery plan and campaign messaging at place level and to local communities?
  • Does the plan set out how the ICB will support patients and staff to understand new ways of working in general practice?
  • Has communications/engagement support been secured to promote alternative non-general practice access routes to the public, in particular community pharmacy and self-referral options?

Supporting information

NHS England has established a regional communications advisory group with one ICB representative per region, ICBs should link in with regional comms reps.

Co-production and patient voice

  • Has the plan been co-produced with patients and local communities?

Supporting information

3. Submission of plans to public boards

ICBs are required to take system-level plans to their public board in October/November 2023 and provide an update in February/March 2024. ICBs should use their discretion regarding the format of board reports and utilise existing templates and processes as appropriate. The prompts/considerations in this briefing note are intended to also help support boards in the task of assuring plans.

4. Regional contacts

North East and Yorkshire

North West


East of England


South East

South West