Political 'changing goalposts' blamed for GP extended access delay

Speaking at an Oxfordshire CCG board meeting, the county’s locality directors said that as “the goal posts kept changing [related to the fund], almost weekly, plans had to be started again”. The board blamed “national political decisions” for GP transformation plans being “deemed unacceptable”.

The GP access fund is a continuation of the prime minister’s challenge fund, with £150m committed since 2013 to pilot ways for GP surgeries to improve access to services. Oxfordshire secured £4.9m of funding from NHS England last March as part of the second wave of GP access fund pilots. This was to enable three Oxfordshire GP federations to run local access hubs, home visiting teams and email consultations.

July board papers, published at the end of last month, said the rollout of “extended primary care services” at a community centre in Rose Hill, which currently only provides basic health advice through a gym facility, had been approved by the Oxfordshire primary care commissioning committee but was on hold due to “uncertainty” around funding.

The Oxford city locality clinical director, David Chapman, blamed the problems on the GP access fund policy, saying it “was believed money was available only to have it pulled away causing the whole plan to fall down”.

On 21 July, seven days before its monthly board meeting, the CCG “received new draft core requirements for the GP access fund”, which it described as “stretching”. The revelation, recorded in papers presented at the September meeting, said the CCG and GP federations involved felt that “most” requirements could be met by the end of December. However, the document said this was “dependent on contracts being signed by the end of September 2016 and staff [being] available to provide the new service”.

The CCG has confirmed to HSJ that contracts have not yet been signed. A CCG spokeswoman would not confirm if it had received all or part of its expected funding. She added: “We are actively discussing with our local GP federations the possibility of delivering services funded by the GP access fund.

The CCG later told HSJ in a statement: “The CCG is proposing to commission health provision at the Rose Hill community centre in Oxford, which will be partly funded by the CCG.

“The remainder of the funding is expected to come from the GP access fund and should be the full amount. However, there are further discussions with providers on this and contracts are expected to be signed at the end of October 2016.”

When asked for clarification of when and how eligibility criteria changed, a spokesman for NHS England said: “We have not previously set national requirements (only selection criteria), as the GP access fund schemes were pilots testing a range of innovative approaches to improve access to GP services. The core requirements were published as part of the planning guidance last month.”

It is unclear exactly which criteria have caused problems.

However, NHS England’s planning guidance specified that eligibility for the GP access fund was dependent on providing “an additional 1.5 hours a day” of evening appointments that must take place after 6.30pm. It also said the additional consultation capacity per 1,000 population must rise from 30 minutes to 45 minutes – but gave no clear timeline for this increase. Detailed measures were included around advertising of services, ease of access and an approach to inequalities.

In contrast, papers from the CCG’s primary care commissioning committee dated 2 June setting out ”five national criteria” referenced “30 minutes per population” of additional consultation time, not 45 minutes, and included access to pre-bookable appointments in “evenings and weekends, both Saturdays and Sundays” without a specific time allocation being mentioned.