Organisation objective

• NHS Mandate from Government

Executive summary

The Delivery plan for recovering access to primary care was published in May 2023 with an overarching ambition to tackle the 8am rush and make it easier and quicker for patients to get the help they need.

It set out 14 commitments in four areas; empower patients, implement ‘Modern General Practices Access’, build capacity, and cut bureaucracy. In the six months since publication, significant progress has been made in all key areas of the plan despite a challenging backdrop.

Action required

The Board is asked to note the information provided in the report.

Background

1. General practice delivers more than a million appointments every day and half a million more every week than pre-pandemic (Appointments in general practice, January 2023 (excludes COVID-19 vaccinations)). Despite this Primary Care, like many parts of the NHS, is under pressure and demand will increase as the population ages (People aged 70 or over have on average five times more GP appointments than young people. NHS Digital Clinical Practice Research Datalink (~10 per year for 70+ and 2 per year for 11–19)).
2. The Fuller Stocktake built a consensus on the model of care for primary care with three essential elements: streamlining access to care and advice; providing more proactive, personalised care from a multidisciplinary team of professionals; and helping people stay well for longer.
3. The Delivery plan for recovering access to primary care published in May, focuses on the first element of the vision and sets out a series of commitments to improve access and make it quicker and easier for patients to get the help they need from primary care. Taking the pressure off primary care, for staff and patients alike, will support overall implementation of the Fuller stocktake vision and recommendations.

Delivery against the four key areas of the recovery plan

A. Empowering patients

NHS App expansion

4. The NHS App provides a convenient route for patients to contact their practice and view their records. We are on track for 90% of practices to enable prospective records access by March 2024. As at November this stood at 75.5%, an increase of 49.3 percentage points since August 2023 (26.2%). In addition, the NHS has met the targets for 90% of practices to offer patients the ability to book/cancel appointments online (91.5%) and 90% of practices to offer patients the ability to order online repeat prescriptions (97.1%).

Expanding self-referral

5. The Delivery Plan noted more than 30,000 people already self-refer each month and asked systems to expand this for carefully considered community-based services from September 2023 including musculoskeletal and podiatry services. By September, ICBs reported good progress with over 600 services reported by ICBs as offering self-referral routes.

Pharmacy oral contraception and blood pressure services

6. 80% of people in England live within a 20-minute walk of a pharmacy and there are twice as many pharmacies in areas of deprivation. Building on this convenience and safety, we have announced that blood pressure monitoring will be expanded from December 2023 and we are introducing direct prescribing of oral contraceptives, which is clinically safe and has been well received. From spring 2024 we expect up to 2.5m blood pressure checks a year could be carried out – up from 900,000 last year. Estimates suggest this could prevent more than 1,350 heart attacks and strokes a year. We expect almost half a million women will able to access the pill next year without needing to contact their GP first. As more pharmacies begin offering the oral contraceptive service, nhs.uk web page will be updated so women can check which pharmacy near to them is offering access to contraception.

Pharmacy First launch

7. The Pharmacy First service is preparing to launch from 31 January 2024 and will enable pharmacists to supply prescription-only medicines where clinically appropriate, to treat seven common health conditions (sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women) without the need to visit a GP. Delivery remains challenging due to changes needed in digital infrastructure and we are working with suppliers to support January implementation. A public campaign is planned for 2024.

B. Implementing modern general practice access

Digital telephony including call back functionality

8. Digital telephony is a key enabler in improving people’s ability to contact their practice. At launch we estimated 70% of practices used digital telephony. At October 2023 this was 83% and we are working with ICBs to support all practices to go live by end of March 2024.

Digital tools and care navigation training

9. To support practices to access high quality online consultation, messaging and booking tools, we are releasing a new digital procurement framework. This will launch in January 2024. However, while the framework will accelerate uptake as products are bundled together, practices are being supported to access available products now through the existing framework and funding. They are also being supported to begin preparatory work now so they are in a position to utilise the framework as soon as it goes live.
10. Around 15% of GP appointments could be navigated to self-care, community pharmacy, admin teams or other more appropriate local services (Malby B, Downham N, Hufflett T (2018). Organisational development is essential to support systems change in primary care. London Southbank University). The NHS has made care navigation training available for every practice in England and to date have over 4,500 staff registered and over 2,000 have completed training.

Transformation support for practices

11. The NHS has implemented the National General Practice Improvement Programme with support provided to more than 1,200 practices. Early findings from the initial cohort are positive and include a 20% drop in practice call wait times, a 50% reduction in abandoned calls and a near doubling of the use digital access by patient to contact practices.

C. Build capacity

26,000 more direct patient care staff

12. There are currently 31,370 additional Direct Patient Care roles meaning the NHS met and exceeded its ambition for 26,000 more direct patient care professionals in general practice by March 2024 (from 2019) strengthening the foundation for multidisciplinary working.

Further expand GP training and encourage GPs to stay in and return to practice

13. The NHS Long Term Workforce plan sets out plans to significantly expand GP specialty training and ensure the NHS can recruit and retain the workforce it needs in the future, alongside an expanded and empowered wider primary care team. From May 2023, we made it easier for doctors to return by replacing the fixed set of multiple assessments with an individual pathway based on a personal review and we are investing in GP retention schemes.

Change local authority planning guidance this year (DHSC-led)

14. DHSC are working with Department for Levelling Up, Housing & Communities (DLUHC) to finalise changes to local authority planning guidance this year to raise the priority of primary care facilities in considering how funds from new housing developments are allocated. ICBs are also working with local stakeholders where housing developments are putting pressure on services.

D. Cutting bureaucracy 

Reducing time spent liaising with hospitals

15. ICBs have been asked to report progress by December 2023 on work to improve the primary and secondary care interface including: onward referrals; complete care (fit notes and discharge letters); call and recall; and a point of contact for clinicians. Subject to review of the reports, we will work with ICBs to support them to effectively and efficiently reduce the time GPs spend liaising with hospitals.

Reduce requests to GPs to verify medical evidence (DHSC-led)

16. Government is taking forward work to reduce unnecessary demands on GPs to verify medical evidence, including by increasing self-certification, by continuing to advance the Bureaucracy Busting Concordat.

Streamline the Investment and Impact Fund (IIF)

17. In the 2023/24 GMS contract, we streamlined the IIF from 36 to five indicators, retargeted £246 million and protected 25% of Quality and Outcomes Framework (QOF) clinical indicators. This has helped free time to focus on improving access.

Roll out of easy-to-use online registration service to 2,000 practices

18. Conventional patient registration processes can be complex and resource intensive for practices and patients with around 6.8m processed annually. A new online patient registration service and paper form has been co-developed and tested with relevant groups including general practice staff and is now available to all practices across England. The NHS has achieved its commitment early for 2,000 practices to be using this service in November, one month ahead of schedule.

Conclusion

19. Six months into implementation, the plan remains well supported by key stakeholders including the profession. We are meeting many of our commitments early. We are beginning to see examples from the frontline on how access and experience is improving. We have made good progress against milestones and some key metrics are improving. While encouraging, we expect these to be challenged through winter. Although not without risk, current focus is on achieving key milestones to make a step change in access for patients including expanding pharmacy services and digital enablement that will support modern general practice such as use of the NHS App and digital telephony.