Overview

1. The purpose of this document is to provide guidance to integrated care boards (ICBs), primary care networks (PCNs) and practices on how to access the transition cover and transformation support funding referenced in the Delivery plan for recovering access to primary care (the Delivery plan). It also covers what this funding should be used for and how it sits alongside other support provided in the Delivery plan to help practices move to a modern general practice access model.

For more information on the modern general practice access model, please see the Delivery plan, this webinar and accompanying slides on the FutureNHS platform (this platform requires a log in).

2. In summary, practices will be able to receive an average of £13.5K to enable them to pay for additional support to help clear existing work before they transition to a modern general practice access model.

Transition cover and transformation support funding

3. The Delivery plan for recovering access to primary care was published on 9 May 2023. The plan sets out two central aims:

1. to tackle the 8am rush and reduce the number of people struggling to contact their practice and
2. for patients to know on the day they contact their practice how their request will be managed.

4. To achieve these aims, the plan set out support, funding and other actions that would be put in place to help general practice to move to a modern general practice access model. Annex 2 sets out the funding available through the programme. By moving to the model, practices will be better able to: see and understand all expressed demand and all current capacity; reduce avoidable appointments and allocate capacity equitably and according to need; and make full use of the multi-professional team and improve the working environment for staff, as well as improving experience for patients.

5. Practices that have made the change to a modern general practice access model have shared the importance of clearing backlogs of work before making the change so that new processes and ways of working can start from a clean slate. For practices looking to implement a modern general practice access model the transition cover and transformation support funding – an average of £13,500 per practice – is available to provide additional capacity to help smooth the transition to a new model. The funding could be used, for example, to pay for sessional GPs, support from experienced peers or for additional sessions from current practice staff (clinical or non-clinical). The funding is to be used when the practice is approaching the point of going live with the new model, for example, to clear appointment books.

Transition cover funding – process

6. To access transition cover and transformation support funding, practices need to contact their ICB to confirm that they are planning to make the change to a modern general practice access model and when they will need the funding to support this change.

In determining ‘… when the practice is approaching the point of going live with the new model’ it is recognised that there may be a phased approach to go-live, for example, introducing different aspects of the model. ICBs can therefore consider a phased approach to release of funding to ensure that practices receive this in a timely way, at the point of incurring additional capacity costs. Practices still need to confirm they are planning to make the change and provide the required evidence of this as per the guidance.

7. Practices could do this by including their plans to change to a modern general practice access model and estimated timings within any of the following documentation:

1. Their PCN’s documentation used to establish a baseline position for the Investment and Impact Fund (IIF) capacity and access improvement payment.
2. Requests to the ICB for support as part of the Delivery plan – stated in the checklist to be submitted to the ICB by 15 July.
3. The PCN or practice access improvement plan requested as part of the Delivery plan checklist to be submitted to the ICB by 31 July.
4. Plans developed by the practice relevant to achievement of Quality and Outcomes Framework quality improvement indicators.
5. A separate detailed request (with estimated costings) setting out the support the practice has identified it will need to transition to be a modern general practice.

8. ICBs need to assure themselves that the practice is moving to a modern general practice access model and that funding will be used to support this transition. It is recommended that ICBs make this judgement based on the content of PCN and practice level improvement plans mentioned above, discussions with the practice and through using existing local engagement routes.

9. Practices are encouraged to track relevant data to establish the impact of the changes in their model. Please see Annex 3 for improvement indicators being used as part of the General Practice Improvement Programme to help track the impact of change.

10. Where a practice is participating in General Practice Improvement Programme (GPIP) support (see below) and the practice will make a transition to modern general practice access model during the support work, this will be communicated to the ICB by the GPIP team.

11. There is a total of £88m available (an average of £13.5k per practice), £44m in 2023/24 and a further £44m in 2024/25. £44 million is available to support the above aims in each of the 2023/24 and 2024/25 financial years.

12. A nominal maximum annual allocation per year per ICB is based on a fair share of available funding (please see Annex 1). ICBs should consider the needs and readiness of practices in line with this guidance and plan for the phased use of the funding across 2023/24 and 2024/25.  

13. As funding is available in 2023/24 and 2024/25, ICBs will need to manage the demand for the funding from practices across the two financial years and account for funding appropriately in each year.

14. At a practice level, funding should be proportionate to the transition support required, recognising the average funding of £13,500 available per practice and the nominal allocations. ICBs are expected to assure that costs reimbursed per practice are reasonable and directly incurred in supporting transition to new operating methods.

15. Actual funding made available to ICBs will be based on their confirmation of practice readiness and funding requirements. An initial allocation of 30% of the maximum ICB allocation for year 1 (2023/24) will be paid to ICBs in Q2, with actuals notified by ICBs to NHS England regions and allocations adjusted accordingly.

16. Note that this funding is intended solely to support transition cover and transformation support as described in this guidance – funding will be made available based on actual spend. Funding for 2023/24 and 2024/25 will only be able to be spent in the relevant financial year, for costs incurred in that year. ICBs will need to work with practices to ensure this funding is accessed, whilst assuring themselves it is being used to support the transition to a Modern General Practice Access Model.

17. A template will be provided to NHS England regional finance leads to collate and assure final allocations up to a maximum of the notified nominal allocations and allocations adjusted accordingly. Reporting arrangements for ICBs, including inclusion in the Toolkit, and appropriate coding will be confirmed in due course.

General Practice Improvement Programme (GPIP)

18. The General Practice Improvement Programme (GPIP) is a national programme that has been established as part of the Delivery Plan. The support provided by the programme will help practices and PCNs to move to a Modern General Practice Access Model more easily and will support realisation of benefits more quickly.

19. The GPIP is about bringing together, codifying and sharing learning from other practices and PCNs that have successfully been through change and have seen improvements in patient and staff satisfaction as a result. The programme aims to help practices deliver care in a way that is fairer, and more sustainable.

20. Over the next two years the General Practice Improvement Programme will provide:

• Support for improvement: 3 levels of support for practices or PCNs
  • Universal: webinars, drops in and online content
  • Intermediate (practice): 13 weeks of hands-on support
  • Intermediate (PCN): 12 half-days in person facilitated sessions
  • Intensive (practice): 26 weeks of hands-on support
• Support for capability building in practice and PCN teams to sustain change, including:
  • Fundamentals of change management training
  • GP Quality Improvement leadership programme
  • PCN and Digital and Transformation leads training
• Support for shared learning including working with ICBs to create local peer networks to share challenges and learning alongside a national peer community.

21. The General Practice Improvement Programme (GPIP) support (see paragraph 20, sections a-c above) is nationally funded so there is no cost to practices to receive the support. Practices and PCNs are encouraged to submit their interest in accessing hands-on support via GPIP to their ICB. ICBs should nominate practices and PCNs for hands on intensive and intermediate support.

22. The transition and transformation support funding discussed in this guidance is not linked to the national General Practice Improvement Programme or local support offers, i.e., it is not necessary to participate in GPIP support before requesting or receiving transition and transformation support funding. However, participating in the GPIP will support practices to make the changes and move towards a Modern General Practice Access Model more easily (see also paragraph 10 above).

23. Participation in the General Practice Improvement Programme will also help practices achieve their QOF Quality Improvement demand and capacity and well-being modules.

24. Where PCNs and their member practices need more help to make changes and move to a Modern General Practice Access Model, e.g. backfill to do the preparation work for change or to enable them to have time to participate in support, funding from the Capacity and Access Support Payment via the IIF is available to support PCNs, alongside any additional support available locally via the ICB.

25. More information on the General Practice Improvement Programme and accessing the different support offers can be found on the webpage and in webinar recordings hosted on NHS Futures.

Annex 1 – Maximum fair-share allocations by ICB

Annex 2 – Available funding

There are different types of funding available to ICBs, PCNs and practices that support the objectives of the Delivery Plan for Recovering Access to Primary Care:

IIF National Capacity and Access Support Payment: total £172.2m. Paid to PCNs, proportionally to their Adjusted Population, in 12 equal payments over the 23/24 financial year. Equating to an average of ~£11,500/PCN/month. This is ‘unconditional’ funding.

IIF Local Capacity and Access Improvement Payment: part or all of a total of £73.8 million, paid to PCNs based on commissioner assessment of a PCN’s improvement in three areas over the course of 2023/24. The maximum a PCN could earn is £1.185 multiplied by the PCN’s Adjusted Population as of 1 January 2023. This equates to ~£56,000/PCN/year.

The payment of the Local Capacity and Access Improvement Payment should be made based on a PCN making improvements in three key areas: (1) patient experience of contact; (2) ease of access and demand management and (3) accuracy of recording in appointment books. This funding was included in the 23/24 contract/allocations.

Transition Cover and Transformation Support Funding (average of £13.5k/practice):

This funding to be made available as per this guidance.

Primary Care Service/System Development Funding: provided to ICBs to deliver transformation and other programmes (see guidance: Primary care service development funding and general practice IT funding guidance 2023/24)

In addition to the above, the Delivery Plan provides nationally funded training and support and additional funding for digital tools as follows:

• Digital telephony – £90 million distributed based on need to support practices to move from analogue to cloud based telephony systems available via national frameworks
• Online consultation, messaging and appointment booking tools: £71 million – the majority added to ICBs’ allocations to spend on accredited digital systems that will be made available via a national digital pathways framework in August 2023. A percentage to be retained nationally for commercial work to develop procurement frameworks and standards and to take forward national interoperability work.
• Care navigator training – funded and contracted nationally. Practice and PCN managers to nominate one member of staff to complete the training.
• The General Practice Improvement Programme – see above.

The implementation of the Delivery Plan will also be supported by a nationally funded communications campaign to explain the new model of general practice to the public.

Annex 3: Improvement indicators

The General Practice Improvement Programme is designed to support practices to make changes across the following five areas, which in turn will support implementation of the Modern General Practice Model: 

• Understanding and use of demand and capacity
• Care navigation and triage
• Improving the telephony journey
• Improving the patient online access journey
• Non patient facing workload management.

The improvement indicators below (baseline and follow-up data) will be used by the General Practice Improvement Programme to support practices and PCNs to understand the impact of the changes they are making across five areas above. Understanding change against these indicators will also support NHS England to assess the effectiveness of the General Practice Improvement Programme.

1. Number of phone calls answered (call volumes) per 1,000 registered patient population.
2. Call length times 
3. Call times to answer (wait times) 
4. Number of abandoned calls (dropped calls) per 1,000 registered patient population. 
5. Online consultation submissions (clinical and administrative) per 1,000 registered patient population 
6. Percentage of avoidable appointments (via online audit tool provided by programme)
7. Percentage of patients requiring continuity of care for their appointment where it was not met(as part of avoidable appointments audit above) 
8. Staff experience (via GPIP staff experience survey and temperature check)
9. Staff feedback on support offer (via GPIP feedback tools)
10. Patient experience (via national General Practice Patient Survey – No programme data collection required)

Publication reference: PRN00574