How to approach the 23/24 GP Contract Access Requirements

At THC Primary Care, we provide resources for Primary Care Network Leaders.

In our blog titled The PCN DES 23/24 for Primary Care Network Leaders | What to focus on in Q1, I clearly stated that the PCN DES should not be viewed in isolation as further guidance and contract changes will impact practices and how they view and engage in their network's activities.

Amendments to the GP contract have now been made official, so in this blog, I spoke with Dr Ishani Patel, GP Partner, North West London Digital First Clinical Lead and Co-Founder of Lantum, to get a greater understanding of how these changes can be implemented in practice.

In this blog, Dr Ishani Patel shares the importance of:

1. Understanding your baseline to understand the scale of the change which needs to be made

2. Deciding on and keeping your own performance data

3. Collaborative working to develop or build on hub-based working

Before we jump in, I wanted to better understand how access has developed over time.

The issue with access is that it can be:

• Highly emotive

• Very technical

• Much debated

• Politically charged

Some practices seem to manage the demand expected of them extremely well, whilst others struggle.

This visual isn't a complete history, but I think this will be helpful to those relatively new to primary care networks to help them put into context the latest access requirements.

Background to the 23/24 Contract Changes

On the 6th of March 2023, NHSE published a letter which shared many changes;

1. Practices will be required to procure their telephony solutions only from the Better Purchasing Framework once their current telephony contracts expire.

2. To ensure consistency in the access that patients can expect, the GP contract will be updated to make clear, that patients should be offered an assessment of need or signposted to an appropriate service at the first contact with the practice.

The full letter can be found here: https://www.england.nhs.uk/long-read/changes-to-the-gp-contract-in-2023-24/

On the 18th of April 2023, The changes to the regulations regarding access [Le1] were laid before parliament and will come into force on the 15th of May, stipulating that the practices have to provide ‘an appropriate response’ to patients the first time they contact the practice, and defined the response as:

• ‘invite the patient for an appointment, either to attend the contractor’s practice premises or to participate in a telephone or video consultation, at a time which is appropriate and reasonable having regard to all the circumstances;

• provide appropriate advice or care to the patient by another method;

• invite the patient to make use of, or direct the patient towards, appropriate services which are available to the patient, including services which the patient may access themselves; or

• communicate with the patient— to request further information; or as to when and how the patient will receive further information on the services that may be provided to them, having regard to the urgency of their clinical needs and other relevant circumstances.’

• The Statutory Instruments document detailing the changes to the GP contract can be found here: https://www.pulsetoday.co.uk/news/breaking-news/gps-must-offer-appropriate-response-to-patients-on-first-contact-from-15-may/

Tara: Where should we start?

Dr Patel: Firstly, don’t panic.

I would start with:

1. Carefully reading the contract amendments and discussing these with your practice and PCN team

2. Understanding the size of your problem and then starting to map out a solution

3. Manually accessing how many patients are being asked to call back tomorrow

4. Looking at your digital telephony drop call rate

5. Reviewing the duration of calls when patients reach reception

Tara: The contract stipulates that practices must provide an appropriate response. How do you interpret this?

Dr Patel: It's simply triaging sensibly, based on risk and need and communicating this clearly to the patient.

I say simple, but it's not always easy, but this is what we do.

I would also want to ensure that all members of my team have up-to-date information on services available to ensure they are aware of the full range of options there are to support our patients.

Tara: We all know GPAD is a work in progress, so what should we be thinking about to evidence the changes we make?

Dr Patel: Whatever system you deploy, track your own data and ensure you are doing your fortnightly or monthly data collections.

Keep your data, as sooner or later; someone’s likely to ask:

• What did you deliver?

• What did you do differently?

• What volumes are we talking about in terms of patient appointments, interactions, and signposting?

Tara: What opportunities or key questions could PCNs and practices explore to meet the contract requirements?

Dr Patel: I would be asking PCNs and practices:

1. Do you know how big of an issue this is going to be?

2. Could you organise your ARRS team to support enhanced hub working to tackle your 8 am rush and 4 pm – 6pm rush?

3. Could you review your telephony systems to better segment, signpost and support your patients based on need and urgency?

4. Is there an opportunity to test and trial different capacity models to reduce your drop call rates?

5. Do you have an established enhanced access model you can build on?

6. How efficient is your online and telephone triage? Is there an opportunity to finesse your current systems and protocols?

I would also continue to:

• Build your PCN workforce.

• Emphasise to your patients the wide range of professionals available to them within your practice/ across the network.

Tara: Can you share any examples of best practice?

Dr Patel: In one PCN, they have hit all their ARRS recruitment and have built a pharmacist-led PCN hub that will do the triage of the online consultations, the script requests and other things that avoid people having to queue up at their practice.

They've got their single point of access model already configured. So, if a patient is struggling to get through to their own surgery, they can then ring their centralised PCN number.

Tara: Where do you foresee difficulties with implementing the changes to the GP contract when it comes to access?

Dr Patel: It's not going to be easy for a practice that doesn't have a PCN with a digital access hub or hub-based working as part of their network vision as things progress.

It's not impossible, but it will require some pathway working.

Now is an excellent opportunity for PCNs to be running meetings and workshops with their membership practices, asking them.

• What are you worried about?

• What are your ideas?

• What would you like us to help you deliver?

Final thoughts

1. Don’t wait. The changes were announced on the 6th of March, and these changes are due to come into play on the 15th of May.

2. Meet with the practice and PCN colleagues to understand your baseline and discuss potential models of working.

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

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

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

6. Use a quality improvement approach to organise your approach and track your progress.

We hope this helps!

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About The Author

I'm Tara; I am the founder of THC Primary Care, an award-winning healthcare consultancy specialising in Primary Care Network Management and the host of the Business of Healthcare Podcast, where we have now published over 200 episodes. I have over 20 years of project management and business development experience across the private and public sectors, and I have supported over 80 PCNs by providing interim management, training and consultancy. I have managed teams across multiple sites and countries; I have an MBA in Leadership and Management in Healthcare, I'm published in the London Journal of Primary Care, and I am the author of over 250 blogs. I have 3 children. My eldest has Asthma, my middle child has a kidney condition called Nephrotic Syndrome, and my youngest daughter has Type 1 Diabetes, so outside of work, healthcare plays a huge role in my life.