Summary of support offer for practices and PCNs

Updates to the summary of support offer include:

• Revised timescales for Digital Pathway Framework
• Link added for transition cover and transformation support funding guidance
• Additional information provided on digital and transformation lead training.

Commitment: Modern general practice access

1. Financial and procurement support

Support given to any practice that indicates to its ICB that it wants to move from analogue to digital telephony.

The Better purchasing framework is live with qualifying suppliers.

• Timeline: final date 1 July 2023.

2. Funding of high quality tools

Funding provided for online consultation, messaging, self-monitoring and appointment booking tools.

Online consultation tool pre-guidance published by June (complete).

Digital Pathway Framework lot on digital services for integrated care (DSIC) during summer-autumn 2023, and fully launched in December 2023 with supplier contract

• Timeline: all products funded by new framework due by December 2023.

3. National General Practice Improvement Programme (GPIP)

GPIP provides nationally funded tailored support through 23/24 and 24/25 to practices and PCNs to help them implement modern general practice and realise the biggest benefits in the shortest timeframe.

It includes four elements:

• Universal support:
  • ‘how to’ guides, webinars and online support sessions available to all practices and PCNs.
• Intermediate support for practices and PCNs:
  • three months of hands-on facilitated support for practices, and six months of hands-on facilitated support for PCNs.
• Intensive support for practices:
  • six months of hands-on facilitated support.
• Capability building:
  • provides individuals in practices and PCNs with practical development programmes that will increase their core skills and understanding of quality improvement (QI) tools and techniques, and managing change as well as support ICB to establish or further develop local communities of practices to enable peer-to-peer learning.

See the NHS England GPIP webpage for more information.

• ICBs to nominate practices and PCNs likely to benefit from intensive and intermediate support offers (up to 1,550 practices for 2023/24 and up to 1,650 practices for 2024/25).

4. Transition cover and transformation support funding

Provided where practices/PCNs are transitioning to the Modern General Practice Access Model and require additional support (eg extra practice shifts, locums, or peer support).

An average will be used of £13,500 per qualifying practice of flexible funding through capacity fund reimbursements. Available through 2023/24 and 2024/25.

See published guidance on transition cover and transformation support funding.

• Timeline: agree with ICB as required through 2023/24 and 2024/25 using recovery planning process.

5. Training

Care navigation training:

• Every practice can nominate to their ICB one member of staff to undertake care navigation training (see FutureNHS), which commenced on 10 July.

Digital and transformation lead training:

• This is designed to equip individuals in the ‘digital and transformation lead additional roles and reimbursement scheme (ARRS) role’ with the core skills to lead transformational change.
• Every PCN can nominate one lead to undertake training.
• More information is on the NHS England GPIP capability building webpages.

• Timeline: nominated through 2023/24 and 2024/25.

6. Improving access

Repurposed £246 million of the Investment and Impact Fund (IIF) to support improving access and provide capacity for transformation:

• Reduced IIF indicators from 36 to five, releasing staff capacity.
• Approx £172.2 million to be unconditional ‘capacity and access support payment’, paid monthly from April (approx £11,500 per month, per average PCN).*
• Up to £73.8 million to be ‘local capacity and access improvement payment’ (CAIP), awarded based on commissioner assessment of improvement in access performance: specifically, patient experience of contact, ease of access and demand management, and accuracy of reporting in appointment books (paid no later than 31 August 2024).

For further information, guidance on the DES capacity and access improvement payment was released on 30 March 2023.

• Timeline: ongoing in 2023/24.

* Funding is additional to core PCN funding, the clinical director payment and the PCN leadership, management payment and ARRS funding.

7. Increase in ARRS flexibility and ARRS numbers

Increase ARRS funding by £385 million.

Increase flexibility by including apprentice physician associates and advanced clinical practitioner nurses.

View guidance and ‘Practice and PCN income ready reckoner’ calculator on the NHS England website.

• Timeline: ongoing in 2023/24.

8. Communications

Communication materials are available for all practices to support patients in understanding:

• digital access to practice
• NHS App for repeat prescriptions
• multidisciplinary general practice teams
• the wider care available: pharmacy and NHS 111.

There are also other materials that practices may find useful:

• Enhanced access
• ‘Looking after you’ coaching
• Staff respect.

• Timeline: ongoing in 2023/24.

Checklist of key practice/PCN actions

Where possible, PCNs should leverage scale and act together (eg in procurement of digital tools and telephony, and in developing recovery plans), but there will be variation, and some actions will happen at the practice level.

Updates to key practice/PCN actions include:

• Action 9 – now references guidance shared with regions.
• Action 10 – link included for draft GPAD guidance which is undergoing testing with practices.
• Action 12 – clarifies digital telephony functionality.
• Action 13 – clarifies timescale for ICBs to identify digital tools.
• Action 14 – updated to reference importance of maximising digital tools already available and in use.
• Action 18 – now references a system-wide approach to improving the primary-secondary care interface and reminds practices to share examples of bureaucracy.

Commitment: Empowering patients

Practices/PCNs have enabled all four NHS App functions for patients

1. Apply system changes or manually update patient settings to provide prospective record access to all patients.

• See regulation, support, guidance and checklist.

• ICB assurance measure (how will this be assured by ICBs?): Patient online management information (POMI) – percentage of practices that have enabled prospective records, repeat prescriptions, secure messaging and managing.
• Timeline: due by 31 October 2023.

2. Ensure directly bookable appointments are available online following bookable online appointment guidance.

• ICB assurance measure: POMI.
• Timeline: due by 31 July 2023.

3. Offer secure NHS App messaging to patients where practices have the technology to do so in place.

• ICB assurance measure: POMI.
• Timeline: ongoing.

4. Encourage patients to order repeat medications via app, supported by NHS Digital communications toolkit.

• ICB assurance measure: POMI.
• Timeline: ongoing.

Practices enable self-directed care

5. Use messaging software to support patients to communicate with practice, including for self-monitoring (where not in place – see ‘digital tools‘ section below).

• ICB assurance measure: ICB assessment.
• Timeline: ongoing.

Commitment: Modern general practice access

Complete IIF CAIP baselining and recovery planning

6. Complete pre-work and fill in template (Annex B IIF CAIP guidance) to baseline existing position.

• ICB assurance measure: submit to ICB for sign-off.
• Timeline: agreed and submitted by 30 June 2023.

7. Confirm to ICB request move from analogue to digital telephony.

• ICB assurance measure: submit to ICB for sign-off.
• Timeline: due by 1 July 2023.

8. Confirm requested support offers to ICB (including care navigator/digital and transformation lead training, GPIP transformation support, capacity backfill support [for transition cover and transformation support funding], higher quality online consultation tool, etc).

• ICB assurance measure: submit to ICB for sign-off.
• Timeline: due by 15 July 2023.

9. Complete PCN/practice access improvement plan* with committed offers.

• Guidance shared with regional leads.

• ICB assurance measure: submit to ICB for sign-off.
• Timeline: due by 31 July 2023.

* As specified in Network Contract DES IIF Capacity and Access improvement payment guidance. The plan should also cover all the items in this practice/PCN action checklist.

10. Sign self-certification of accurate recording of all appointments and compliance with GP appointments data guidance (guidance on 17 appointment categories; guidance on which categories are same-day; guidance on which categories are two-week).

• Additional simplification and unified draft guidance published on FutureNHS.

• ICB assurance measure: assessment by ICB of correct use of categories or improvement.
• Timeline: sign self-certificate and be assessed by 31 March 2024.

11. Make improvements identified in practice/PCN access improvement plan (related to actions 6, 7, 8, and 9) and report to ICBs.

• ICB assurance measure: assessment by ICB using relevant measures identified during pre-work.
• Timeline: due by 31 March 2024.

Digital tools and implementation (including telephony, online consultation and messaging tools)

12. If already on digital telephony, ensure call-back functionality and queuing is enabled, where the functionality is included in the current contract costs.

• ICB assurance measure: assessment by ICB of improvement from April 2024.
• Timeline: due by 31 July 2023, and assessment from April 2024.

13. Work with ICB to identify digital tools to procure in preparation for framework launch.

• Further purchasing guidance to be developed through procurement exercise.
• Implement tools once acquired.

• ICB assurance measure: assessment by ICB of improvement from April 2024.
• Timeline: due by 30 November 2023.

14. Use website guidance to update and ensure the user experience is improved, with online tools correctly displayed; and ensure that online tools already available to the practice/PCN are maximised.

• ICB assurance measure: assessment by ICB of improvement from April 2024.
• Timeline: ongoing in 2023/24 and 2024/25.

Care navigation and alternative pathways for patients to use

15. Training all practices in the PCN to understand and use local directory of services, including self-referral, community pharmacy and other services.

• Timeline: due by 31 March 2024.
• ICB assurance measure: local recording of completion of training.

Commitment: Capacity

ARRS planned recruitment

16. Submit ARRS and workforce plan to ICB (Contract specification [p40] and DES guidance [p19])

• ICB assurance measure: data automatically collected via National Workforce Reporting Service (NWRS).
• Timeline: due by 31 August 2023.

Recruitment and retention offer

17. Review and take up local offers for retention; see System Development Funding guidance for 2023/24.

• ICB assurance measure: money/offers awarded to practices/PCNs.
• Timeline: ongoing.

Commitment: Reducing bureaucracy

18. Opportunity to feed back to ICB on progress against primary and secondary care interface difficulties, ensuring a system-wide approach – see Academy of Medical Royal Colleges (AoMRC) report.

• Practices are reminded of the request in the recovery plan to share examples of burdensome bureaucracy in general practice they would like to reduce, or contact the Department of Health and Social Care using the online form link in PCARP.

• ICB assurance measure: ICB public board report.
• Timeline: ongoing.

Checklist of key ICB actions

Updates to ICB actions include:

• Action 1 – reference to all 7 self-referral routes and clarification that expanding direct access is an action in operational planning guidance.
• Action 2 – reference to ICBs supporting expansion of community pharmacy services included.
• Action 3 – updated timescales and purpose for using the commercial hub.
• Action 4 – updated acronym on framework, revised date due, clarified procurement approach.
• Action 5 – updated to clarify action for ICBs in nominating practices for the GPIP and associated timescales.
• Action 6 – added ‘at least’ 850 practices.
• Action 7 – includes link to transition funding guidance and reference to ICBs maximising use of funding.
• Action 8 – includes link to QI capability improvement training.
• Action 11 – references guidance shared with regions.
• Action 14 – includes link to published briefing note.
• Action 16 – additional action for ICB chief medical officers.
• Action 17 – includes reference to a system-wide approach for improving the primary-secondary interface.
• Action 18 – additional action to encourage sign up to ‘Register with a GP service’.

Commitment: Empowering patients

1. Self-referral pathways

Expand self-referral routes (falls services, musculoskeletal services, audiology for older people including loss of hearing aid provision, weight management services, community podiatry, and wheelchair and community equipment services) – as set out in 2023/24 operational planning guidance.

ICBs should also note operational planning action to expand direct access where GP involvement is not clinically necessary.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: due by 30 September 2023.

2. Support expansion of community pharmacy services

Expansion includes the oral contraception and blood pressure services; co-ordinate local communications.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: ongoing.

Commitment: Modern general practice access

3. Digital telephony

Sign up practices ready to move from analogue to digital telephony.

Co-ordinate access to specialist procurement support through NHS England’s commercial hub to achieve and track the transition of the majority of practices from analogue to CBT by 31 December 2023, and the remainder by 31 March 2024.

Determine whether ICB wants to follow scale approach to telephony (see Leeds case study in Delivery plan for recovering access to primary care [p23])

Use peer networks and demonstrations with practices/practice participation groups (PPGs)/PCNs to help practices and PCNs identify and adopt digital telephony.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: due by 1 July 2023 for sign-up; ongoing for co-ordination

4. Use of digital services integrated care products

Select digital tools from the Digital Pathway Framework lot on the Digital Services Integrated Care (DSIC) product catalogue, using user research.

Determine at what scale the procurement approach would align with local need.

Use peer networks, user research and demonstrations with practices/PPGs/PCNs to help practices and PCNs identify and adopt the most usable software.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: Framework due to be available by December 2023.

5. Uptake and participation in GPIP hands-on support

Nominate practices and PCNs for national intensive and intermediate transformation support and encourage uptake and participation in GPIP hands-on support.

Prioritise support to practices working in the most challenging circumstances such as areas of high deprivation and need, rurality, etc. Practices will need to have data from their telephony system to participate in the support programme. See the NHS England GPIP webpages for further information.

Nominate further practices as they implement digital telephony.

ICBs to nominate up to 1550 practices for 23/24 and up to 1650 practices for 24/25 through NHS England phases – forthcoming phases Phase C Intensive by September and Phase D Intermediate by November. ICBs should work with regions to determine population appropriate share of nominations which map to local need.

Use the Support Level Framework during 2023/24 to understand need.

ICBs to establish and/or build on current local peer to peer learning infrastructure to develop local communities of practice to support shared learning and data driven improvement which includes enabling Modern General Practice.

ICBs to put in place a strategy for auditing usability and accessibility of all general practice websites using the GP website benchmark and improve tool. All GP websites to be audited in 23/24 and an improvement plan agreed.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: ICBs to collectively nominate 1,550 practices by December 2023 (allocation of nominations per ICB to be discussed with regional teams to map to local need).

6. Local hands-on support to practices

Fund or provide local hands-on support to at least 850 practices nationally (ICBs should work with regions to determine population appropriate share of target).

We would expect the level of support to be similar to the national GPIP intermediate offer, and offered alongside wider and/or ongoing support for practices and PCNs, where required, to implement modern general practice using the outputs of the SLF to help guide specific support needs.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: due by 31 March 2024.

7. Transition cover and transformation support funding

Agree and distribute transition cover and transformation support funding (an average of £13,500 per qualifying practice) to support practice teams seeking to implement modern general practice.

See published guidance on transition cover and transformation support funding for more information.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: maximise use of ICB allocations for 2023/24 and 2024/25.

8. Training

Encourage uptake and co-ordinate nominations and allocations to care navigator training, and digital and transformation PCN leads training and QI capability improvement training – see NHS England’s capability building webpage for further information.

ICBs should work with regions to determine population-appropriate share of nominations.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: 50% of nominations due by 31 July 2023.

9. PCN/practice capacity

Understand and sign off PCN/practice capacity and access IIF CAIP baseline using guidance and Annex B template.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: due by 30 June 2023.

10. PCN/practice support needs

Agree support needs (digital telephony, online tools, training, capacity backfill, intensive support, etc) with practice/PCN.

Support practice/PCN to secure and put support needs into place.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: agreement due by 15 July 2023; support ongoing.

11. PCN/practice access improvement plans*

Co-develop and sign off PCN/practice access improvement plans – guidance shared with regions in June.

Oversee and support practices/ PCNs in implementation of access improvement plans.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: development and sign-off due by 31 July 2023; implementation support ongoing.

* As specified in Network Contract DES IIF Capacity and Access improvement payment guidance. Plan should also cover all the items in this practice/PCN checklist

12. Assess improvement

Assess improvement and pay 30% CAP IIF funding at the end of year; using progress against baseline and access improvement plans, as well as improvement activity across all three areas over the year, as per the template in DES capacity and access guidance. Further guidance to be issued by 30 June.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: instruct PCSE by 6 August 2024; to be paid by 31 August 2024.

13. Diversion to NHS 111

Set up process for practices to inform of diversion to 111 and monitor exceptional use when over capacity.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: ongoing through 2023/24.

14. System level access improvement

Develop system-level access improvement plans which include:

• summary of practice/PCN improvement plans
• challenges
• wider support needs and barriers
• ICB actions (including leading local improvement communities, leveraging and promoting universal support offer, and improving the quality of core digital patient journeys for patients and staff and usability of practice websites supported by the national website audit tool).

Briefing note published on 31 July to support development of system-wide plans and submission to public boards.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: due by October/November board 2023.

Commitment: Capacity

15. Using full ARRS budget

Support PCNs to use their full ARRS* budget and report accurate complement of staff using NWRS portal.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: ongoing through 2023/24.

* The ARRS scheme is highlighted in the Primary Care Access Recovery Plan. The action is therefore included here, even though it is an ongoing action for ICBs.

Commitment: Reducing bureaucracy

16. Local mechanisms

ICB chief medical officers to establish the local mechanism, which will allow both general practice and consultant led teams to:

• raise local issues to improve the primary-secondary interface
• jointly prioritise working with local medical committees
• tackle the high priority issues including those in the AoMRC report
• address the four priorities in the Recovery Plan.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: due by October/November 2023.

17. Improve primary-secondary care interface

Report in public board updates and plans for improving the primary-secondary care interface (four focus areas highlighted in the recovery plan) ensuring a system-wide approach to actions.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: due by October/November board 2023.

18. Register with a GP surgery service

Support practices to sign up to our Register with a GP surgery service – either on an individual practice basis, or via bulk ICB enrolment and track uptake of the service using regional and ICB data.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: due by December 2023.

Commitment: Enablers

19. System communications

Co-ordinate system communications to support patient understanding of the new ways of working in general practice, including digital access, multidisciplinary teams and wider care available.

This messaging should include system-specific services and DoS.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: ongoing through 2023/24.

20. Directory of Services

Maintain an up-to-date DoS and deliver training to all practices/PCNs on DoS.

• Reporting: report progress into public October/November 2023 board and public April/May 2024 board.
• Timeline: ongoing through 2023/24.