GPs who see less than 20pc of patients face-to-face barred from winter funding

In a guidance document issued today, NHS England has set out further details of how practices can access the funding, following an initial press release issued to media last night.

It says a “minority” of practices are offering “wholly inappropriate” access, with “very low levels” of face-to-face care.

It adds: “In August 2021 over 15 per cent of practices recorded less than 20 per cent of their GP appointments being held face to face. That is likely to be contrary to good clinical practice, even if it were to reflect the preferences of their patients.

Practices which do not offer “appropriate levels of face-to-face care” will be barred from accessing the funds, instead receiving “support” from NHSE.

Yesterday, health secretary Sajid Javid said the measures aimed to tackle the “underperformance” of some practices.

It comes after high profile concerns about GP access — including campaigning by the Daily Mail and Daily Telegraph — and in preparation for extra urgent care demand in winter, while trying to keep under-pressure GPs on side.

The £250m “winter access fund” is from within NHSE’ existing budget, which will have a focus on “increasing capacity to boost urgent same-day care”.

According to the document, practices must:

• Report total appointments delivered in non-practice settings over each month from November to March clarifying baseline, additional capacity and proportion of face-to-face care to show they have achieved “at least” pre-pandemic activity levels. This will exclude covid-19 vaccinations.
• Increase overall appointment volumes in general practice and make sure appointment levels “reflect the full deployment of [non-GP] staff”.
• Increase the proportion of face-to-face appointments with GPs “with a particular focus on those practices with levels that are a cause for clinical concern”. The document adds: “Any practice exhibiting levels of face-to-face care judged to be of clinical concern will not be able to access the fund but should access further support.”
• Minimise 111 calls in-hours and “avoidable A&E attendance” that could otherwise be seen in general practice.
• Support practices to sign up and “make full use” of general practice referrals to the community pharmacy consultation service for minor illness by December.

NHSE’s press statement also said its guidance would “make clear” that GP practices “must seek patients’ input and respect preferences for face-to-face care unless there are good clinical reasons to the contrary”.

NHSE issued a letter in the spring telling practices to offer face-to-face appointments when they were requested, rather than mandating remote triage, which sparked a huge backlash from the profession.

Mr Javid said: “Our new plan provides general practice teams with investment and targeted support. This will tackle underperformance, taking pressure off staff so they can spend more time with patients and increase the number of face-to-face appointments.

“Alongside this we are setting out more measures to tackle abuse and harassment so staff at GP surgeries who work so tirelessly to care for patients can do so without having to fear for their safety.”

When asked on the BBC’s Today programme whether there would be targets on access to face-to-face appointments, Mr Javid replied: “My only target is choice.”

All health systems are being urged to start an “immediate exercise” to look at data and intelligence on their individual practices, including highlighting the 20 per cent of practices locally with the “lowest level of face-to-face GP appointments” – excluding appointments with other staff.

The announcement confirms that newspaper reports from recent days stating that pharmacists would be permitted to prescribe, and that distancing measures in practices would be relaxed are not correct.

Instead, it said consideration would be given to expanding pharmacy’s role, and that the UK Health Security Agency would “complete its review of infection prevention and control guidance…and set out practical steps… which could increase the number of patients that can be seen”.

A series of other measures were also included.

NHSE chief executive Amanda Pritchard said: “Improving access to high quality general practice is essential for our patients and for the rest of the NHS too. It is a personal priority and today NHS England is taking both urgent and longer-term action to back GPs and their teams with additional investment and support.”