Last reviewed 19 May 2023
In this feature Thoreya Swage, Healthcare Consultant, explains the Delivery Plan to Recover Access to Primary Care unveiled by NHS England in May 2023.
The changes to the GP contract for 2023–2024 negotiated between NHS England and the British Medical Association GP Committee recognised the need to improve access to primary care for patients, heralding a follow-up document describing how this would be implemented. In May 2023 the Delivery Plan for Recovering Access to Primary Care was published. A year earlier, an assessment of what was working well and not so well in primary care, the Next Steps for Integrating Primary Care: Fuller Stocktake Report was published examining the access, experience and outcomes for patients which identified, amongst other things, the need to streamline access to care and advice for people using general practice.
What are the main aims?
Two key aims of the Delivery Plan for Recovering Access to Primary Care are to address the 8am rush for appointments and to provide a certain outcome for patients on the day they contact their practice
There are 6500 practices in England delivering over 330 million appointments a year (excluding for Covid-19 vaccinations). Increasingly, patients are wanting to contact their practices via different means; by telephone, in person or online. Continuing with the traditional method of responding to patient requests, ie a receptionist booking an appointment which may be a few days or more from the contact, based on limited information is no longer satisfactory.
The plan proposes that all general practices move to digital telephony by the end of March 2024. The advantage of these systems is that it enables better management of multiple calls, applies a call back function, can direct patients to the right person or team, as well as integrate with clinical systems within the practice to find information quickly.
Patients, particularly of working age, generally prefer to use online services. Although online access was set up in response to the pandemic practices did not have the time to assess fully the range of products or fully implement systems. In recognition of this NHS England is making available to general practice high-quality online consultation, messaging and booking tools by July 2023. Practices will still be expected to have easily accessible and useable websites.
Better navigation, assessment and response
In order to deal with the experience of patients who call their practice with a request and are asked to ring back, the aim of the plan is to ensure that a response the same day becomes the norm and to know how this will be dealt with.
Clinically urgent requests should be assessed on the same day with non-urgent requests scheduled within two weeks if required. Some routine follow-up requests, eg cervical smears may be clinically appropriate.
With around 15% of current GP appointments being suitable for care navigation to self-care, community pharmacy, admin teams or other local services, this becomes an important role for primary care staff. A new National Care Navigation Training Programme for up to 6500 practice staff begins in May 2023.
Other aims of the recovery plan
Direct access to services
Currently more than 30,000 people self refer to services, with many turning to community pharmacies for advice. NHS England is planning to expand the number of community services people can self-refer to, including selected musculoskeletal services, audiology for older people including the provision of hearing aids, weight management services, community podiatry, and wheelchair and community equipment services. These self-referral pathways will be monitored by NHS England in order to ensure appropriate demand. It is estimated that up to 50% of patients could self-refer by March 2024.
Expanding community pharmacy
The role of community pharmacy has been extended over recent years. GPs and NHS 111 can refer patients to community pharmacies for advice and treatment and for urgent medicines supply. In addition, community pharmacies support over 20,000 patients a month when they start new medicines; deliver blood pressure checks and vaccinations including flu and Covid-19.
A new initiative, Pharmacy First launching by the 2023-year end, expands these services by enabling the supply of prescription-only medicines including where clinically appropriate, antibiotics and antivirals, as well as treatments for common conditions such as sinusitis, sore throat, earache, infected insect bites, impetigo, shingles and straightforward urinary tract infections in women, without having to visit a GP. Research will be commissioned to ensure consistent advice to antibiotic and antiviral use between general practice and community pharmacy.
Blood pressure checks and the provision of oral contraceptives will be expanded to cover all community pharmacies. IT infrastructure will be enhanced to enable streamlining of referrals and clinical information between practices and community pharmacy.
Over 16 million people are signed up to the NHS App which gives access to four functions: patients’ clinical records (including test results), ordering repeat prescriptions, seeing messages from their practice (as an alternative to text messages) and managing routine appointments such as vaccinations or B12 injections. The delivery plan (following the 2023–2024 GP contract) requests all practices to enable access to their own clinical records by patients by November 2023.
The plan describes how the primary care workforce will be expanded to support these changes beginning with a commitment to fund 26,000 more direct healthcare professionals including advanced clinical practitioner roles, reimbursement of training time for nursing associates to become registered nurses, recruiting and retaining practice nurses and digital and transformation leads which will help practices to move to new digital tools by the end of March 2024.
As the recruitment of general practitioners has been slower than anticipated, the NHS Long Term Workforce Plan to be published imminently will detail the ambitions to expand GP training and enhance recruitment and retention of doctors (including experienced GPs) and the wider primary healthcare team.
New housing developments place great pressure on existing general practice services. Integrated Care Boards (ICBs) are required to work with local stakeholders to plan for such developments.
ICBs are asked to establish local procedures to reduce bureaucracy across the primary/secondary care interface including the following.
If a patient requires another referral for an immediate or related need once they have been seen in secondary care the hospital can do this without the need to refer back to primary care.
Complete care letters provided to patients on discharge.
Call/recall set up by trusts for follow-up tests or appointments.
Single points of contact for communication between GPs and hospitals, eg one outpatient email for GPs.
Delivering the Plan
ICBs are required to develop their own access improvement plan supporting the changes highlighted in the delivery plan detailing the actions by November 2023, with a further update in March 2024.
To support this plan, NHS England and the Department of Health and Social Care have retargeted over £1 billion, which includes £240 million for technologies and other support, £645 million to community pharmacy and £246 million of the Investment and Impact Fund (IIF) to improving access.
Delivery Plan to Recover Access to Primary Care (May 2023), Department of Health and Social Care and NHS England
Next Steps for Integrating Primary Care: Fuller Stocktake Report (May 2022), Commissioned by NHS England and NHS Improvement from Dr Claire Fuller, CEA (designate) Surrey Heartlands ICS