Government ‘taskforce’ to plan ‘future of general practice’

The 2024-25 GP contract details, published by NHS England this afternoon, said the Department of Health and Social Care would convene a “Taskforce on the Future of General Practice” over “spring and summer” with NHS, patients and other representatives. 

It states: “This will be a key opportunity for the department and NHS England to hear from stakeholders about priorities for change, including through the 2025-26 contract.”

It comes with a general election highly likely to take place this autumn, and Labour — currently strong leaders in the polls — vowing reform in primary care.  

Meanwhile, NHSE detailed a series of measures in the 2024-25 contract, which it said would improve cash flow for practice, increase their flexibility in recruitment, and further steps to cut “bureaucracy” and improve access. 

NHSE primary care director Amanda Doyle, speaking at an NHS Confederation primary care conference today, said: “This is a stepping stone year… The financial position is tight, so some of the more fundamental reform that people are calling for becomes quite difficult to do.

“But what we’re going to do with this contract for next year is take us in the direction that we would be aiming to head for when we do look at more fundamental reform.”

Access

NHSE hopes to “improve patient experience of access” and “better understand overall demand on general practice in advance of winter” by reviewing data on how many people are calling GP practices, taken from new digital phone systems. The contract requires practices to provide digital call data from October — including call volume, time to answer and call length. 

Speaking today ahead of the contract announcement, Dr Doyle said this could help “evidence the size of the demand on general practice” and “escalate” when it “becomes difficult to manage”. The vast majority of practices will have digital telephony by April, she added.

Cash flow and cutting bureaucracy

The NHSE letter said the core funding uplift for practice would be just 2 per cent — a figure attributed to the 2021 government spending review — and which has already been rejected by the British Medical Association GP Committee and other parts of the sector, as it runs well below inflation and previous years’ settlements.

The letter said government may increase this when the Doctors and Dentists Review Body makes its recommendations on 2024-25 pay, expected in the summer. In the meantime, GPs are balloting for industrial action.

On the current plans, NHSE said an overall increase of £259m took contract funding to £11.9bn. 

NHSE said it recognised practice cash flow problems, and would try to help by increasing “quality and outcomes framework” aspiration payments - a part payment to practices in advance of achievement - from 70 to 80 per cent. 

And in a move to help cut bureaucracy, 31 of 76 QOF indicators, which determine practice income, will also be income protected, meaning that practices will receive funding based on performance in previous years.

Likewise, “impact and investment fund” indicators for PCNs will be reduced from five to two. Freed-up funding will be incorporated into the Capacity and Access Payment - an unconditional payment that PCNs can use according to local need, which will increase by £46m to £292m. Performance indicators being axed here relate to the share of patients waiting more than two weeks for an appointment; and flu vaccine uptake. Many performance indicators have already been axed. 

Flexibility and autonomy 

PCNs will have more flexibility around the additional roles reimbursement scheme - which funds roles such as physiotherapists, pharmacists and paramedics - with caps removed for most direct patient care roles and an option to recruit other multidisciplinary roles. 

“Enhanced nurses” (who have postgraduate certification in a specialist area) will be included for the first time but capped at one per PCN or two where the list size is 100,000 or over. 

It will also replace the eight of the current PCN service specifications - which are part of the direct enhanced services  PCN contract - with “one simpler overarching specification”. 

PCN clinical director and PCN leadership and management funding, totalling £89m, will be combined with core PCN funding to give £183m total, as part of an overarching aim to provide PCNs with “greater autonomy over how they can improve outcomes”. 

Further work - such as around improving the primary and secondary care interface - will be provided in an upcoming update on the primary care access recovery plan.