How to approach and what to include in your Primary Care Network Capacity & Access Improvement Plan

If you are a Primary Care Network leader and you have yet to submit your capacity and access improvement plan, this blog is for you.

In this blog we:

✅ Provide an introduction to the local capacity and access improvement plan and payment.

✅ Point you towards the The Delivery Plan for Recovering Access to Primary Care, which provides further rationale to support the improvement plan.

✅ Share 15 top tips to help you to approach your improvement plan.

✅ Share 10 examples of what other PCNs are including in their capacity and access improvement plans.

Lets jump in!

Background

In 2022/23, PCNs were entitled to the Capacity and Access Support payment based on the PCN committing (in writing to the commissioner) to reinvest the payment into additional workforce (and increased clinical capacity) to enable an increase in available appointments and in ensuring better access for patients.

This year, the 2023/24 Local Capacity and Access Improvement payment is a payment which will be made in respect of improvements being made in the following key areas:

• Patient experience of contact

• Ease of access and demand management

• Accuracy of recording in appointment books

PCNs must work with commissioners to assess and record the PCN's position at the start of the 2023/24 financial year in relation to the three key areas set out above.

They must also consider how improvements to the PCN’s position (as of the start of the 2023/24 financial year) will be measured and set the appropriate levels of improvement, which should be achieved by 31 March 2024.

The Local Capacity and Access Improvement payment equates to a MAXIMUM of £1.185 (adjusted pop).

The deadline for the improvement plan is 30th June.

Why are PCNs being asked to review and improve their capacity and access?

The Delivery Plan for Recovering Access to Primary Care provides the rationale and it's definitely worth a read, but here are some highlights to help you to (hopefully) make your plans more meaningful.

💡 One key driver of growth in demand is the ageing population. Most of those over 70 live with one or more long-term conditions and require five times more GP appointments on average than teenagers do.

💡 Overall patient satisfaction scores related to their GP practice fell 10% in 2022; with falls in 99% of PCNs and over 85% of practices. The drop in scores seems to be related to the ‘experience of making an appointment’, which strongly correlates with the ‘ease of getting through’.

What do your patient satisfaction results tell you?

💡 Recent data has revealed that 20% of patients consult their GP for problems which are non-clinical or social in nature.

💡 One of the aims set out in the recovery plan is to help patients care for themselves and make it easier for patients to monitor certain long-term conditions at home. To build on this, the NHS Confederation, supported by Google Health, commissioned Ipsos to undertake targeted research to measure public attitudes towards using health technologies. The research revealed that there is an increasing appetite for using technology to self-manage care and more broadly, to take greater responsibility for our own health, and that of our families.

💡 Practices which have fully implemented the following components tend to have overall patient experience scores which average 6 percentage points higher than the national average:

A. Better digital telephony B. Simpler online requests C. Faster navigation, assessment and response.

This approach is called Modern General Practice Access and is depicted below.

The NHS, like all sectors, has had to innovate, evolve and take service user feedback seriously. We should actively listen to what our patients say they want and need, bearing in mind that wants and needs are not the same (and are not always achievable), but its my personal belief that we should try to see if some improvements can be made.

What to consider when putting together your own Capacity and Access Improvement Plan

If you are yet to develop your Primary Care Network capacity and access plan, we have a few more top tips to support you before the submission deadline on 30 June 2023.

✅ Carefully read the specification. If anything is unclear to you, do not worry, your ICB should provide guidance and if they have not done so, it will be because they are also unsure. Submit your plan with the information you have.

✅ Read the Delivery Plan for Recovering Access to Primary Care to provide further background and context.

✅ Understand the size of your problem and start to map out a solution. This will involve looking at your data and using soft intelligence.

✅ Review your digital infrastructure. What is working well, and what could be improved?

✅ Think about your key performance indicators and how you plan to capture and present your data.

✅ Review your workforce and your access points. Start to make small improvements, and stay in close communication with your ICB if you foresee problems.

✅ Ensure the website clearly articulates all the different ways you can get the services you need. Are you using any online consultation providers? Are you able to submit simple things?

✅ Adopt a quality improvement approach and track your progress.

✅ To better understand your demand, consider manually recording how many patients are being asked to call back tomorrow, review your digital telephony drop call rate or review the duration of calls when patients reach reception.

✅ Consider non-digital solutions by upskilling your staff and getting suitable templates in place.

✅ Work directly with the reception and practice staff to explore data and their experiences asking:

What is working well?

The data says ....... what do you think?

What is your experience of ...XYZ?

What is within our control to change?

What are the issues and what can we start to think about before moving forward?

✅ Put in place a nominated person within the PCN responsible for monitoring GPAD data and liaise with the ICB to identify and discuss any variability noticed within the network and try to reduce it.

✅ Request ICB support to incorporate all patient–related care activities are being captured. More information on GPad can be found here.

✅ Consider whether you are fully optimising the functionality within the tools you have. For example; within the telephony system, are you using the callback functionality OR within your workflow functionality, can a patient self-refer themselves (for a physio appointment e.g.)?

✅ Make time to really understand what the NHS app does and promote this to your patients.

The questions on the graphic below may also provide some helpful prompts.

What are PCNs including in their Capacity and Access plans?

Please find below some improvements PCNs are pursuing:

• Actively promoting the Friends and Family Test and reviewing the data monthly.

• Establishing consistent protocols and information for patients (and practice staff) to ensure patients are signposted to the right team.

• Creating an up-to-date repository of services to aid signposting, which is accessible on each practice's website.

• Adoption of Hero Health, which is a self-booking app to enhance the patient experience when booking.

• Implementing the NHSE Collaboration tool, which promotes shared decision-making. This tool helps patients, prior to them having the appointment, to think about what they want to discuss in the appointment.

• Process mapping patient feedback points to reduce duplication and maximise engagement.

• Establishing monthly network meetings with access and capacity on the agenda to promote a continuous cycle of improvement.

• Piloting a GP triage system between 8am and 10am. This involves a GP sitting in reception to work with reception staff to book patients in the most appropriate clinician clinics to maximise appointments.

• Patient education through PCN PPGs and to spread awareness of PCN ARRS roles.

• Sharing regular, quarterly newsletters for patients to keep them updated on any changes and to include a 'meet the team section' highlighting staff's skills and competencies.

How can you measure your improvement?

You could look to meaure:

🎯 Appointment types (telephone, online consultations, home visits etc…).

🎯 Appointment utilisation on certain days or roles.

🎯 Call drop rate.

🎯 The number of staff engaged in training.

🎯 Number of referrals.

🎯 Variation.

🎯 Patient and staff satisfaction

🎯 Visits to website pages

Final thoughts...

💡 Put your network needs first. Work with your practices and do not force network-wide projects if the will and / or engagement isn't there. This could undo all of the great work you have done to date.

💡 Build on / maximise what you already have.

💡 Small changes can make a big difference.

I hope this helps!

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About the Author

Tara and Team THC provide project and network management and training to Primary Care Networks. Between our training programmes, facilitation and interim network programmes, we have now supported over 120 PCNs!

Tara has an MBA in Healthcare Leadership and Management, is published in the London Journal of Primary Care, is the author of over 200 blogs and also hosts The Business of Healthcare Podcast.

Find out more about THC Primary Care at www.thcprimarycare.co.uk