The Primary Care Network June 2024 Update

Check out our summary of the latest updates affecting primary care networks in June 2024.

We cover:

1️⃣ The recently scrapped Digital Pathways Framework

2️⃣ The Community Pharmacy Primary Care Network Engagement Role

3️⃣ Accurx Self-Book

4️⃣ The ballot for collective action for GPs in England

5️⃣ Clarifying the role of the physician associate

6️⃣ How to improve care navigation in general practice

7️⃣ Capacity and Access: "Is it worth moving all practices to total triage to claim the faster care navigation element?"

8️⃣ 100% Payment for 23/24 IIF ACC-08 Indicator

Let's jump in!

 1. Digital Pathways Framework Scrapped

On 6th June, NHS England shared that the digital pathways framework will no longer be published.

This framework was designed to support ICBs, PCNs and practices to deliver the modern general practice access plan by providing a list of approved tools that would be available to underpin functions including booking, messaging and online consultations.

While it's the end of the road for the framework, practices should still be able to secure the higher quality digital solutions they need via their ICBs utilising in-year funding provided as part of the primary care access recovery plan.

The ICB should be your first port of call before funding any tools yourself.

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For PCNs who are looking for guidance to inform their digital purchasing decisions in the absence of the digital framework, check out this guide outlining 12 questions you should be asking when considering the pros and cons of purchasing any digital solution with patient usability and performance monitoring in mind.⬇️

https://www.thcprimarycare.co.uk/post/12-key-questions-every-primary-care-network-should-consider-before-purchasing-a-digital-solution

2. The Community Pharmacy Primary Care Network Engagement Role

NHSE announced the community pharmacy primary care network engagement role to support the regional implementation of the Primary Care Access Recovery Plan.

The engagement role is designed to develop channels of engagement between community pharmacies and PCNs and build partnerships that support integrated clinical pathways for patients.

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The role is expected to function as a point of contact for local community pharmacies and general practices in the PCN. 

For more details, check out ⬇️ https://www.thcprimarycare.co.uk/post/the-community-pharmacy-primary-care-network-engagement-role-an-opportunity-or-doomed-to-fail

3. Accurx Self Book

NHS England funding for Accurx Self-Book will end on June 30th. To continue using it, individual practices and/or ICBs will need to pay for this.

We asked members of the Primary Care Network Discussion Forum what this change means for them.

➡️ Some ICBs are funding using their transformation funding

➡️ Some PCNs are funding directly

➡️ One member shared they were looking at abtrace to run along the side of accurx as they have all fees included

➡️ One PCN is using Amena

➡️ One member shared they were looking into the full capabilities of what SystmOne can do first

🎯 It's worth double-checking how this will affect your practices and whether you can use PCN funding to support it.

4. The ballot for collective action opens for GPs in England

On the 17th June, The BMA’s ballot for collective action opened for GPs in England. The ballot closes at midday on Monday 29th July.

What does 'collective action' mean?

In a statement, the BMA says: “Collective action is not the same as strike action”. Action could see GPs withdrawing from data-sharing agreements or pushing back against NHS England to instead offer face-to-face appointments as a default. 

An article published by Pulse on 6th June details some further examples of what the collective actions could look like presented at the BMA roadshow in Stafford found here: https://www.pulsetoday.co.uk/news/workforce/bma-reveals-options-for-gp-collective-action/

Many practices are under significant pressure, which will understandably affect levels of engagement in your primary care network.

Greater insight into challenges faced by practices can be found here: https://www.bma.org.uk/bma-media-centre/gps-leaders-in-england-vote-to-launch-a-ballot-for-collective-action

5. Clarifying the role of the physician associate

On June 8th, CQC published guidance to clarify the role of the physician associate (PA) in general practice, updating the original guidance to include information on supervision and oversight and information about what physician associates can do.

The guidance follows an NHS England publication that emphasises that PAs are not substitutes for general practitioners or doctors in training; rather, they are specifically trained to work collaboratively with doctors and others as supplementary members of a multidisciplinary team alongside nursing and other ARRS colleagues.

The guidance also called for;

➡️ All work undertaken by PAs must be supervised and debriefed with their supervising GP.

➡️ Practices review their processes to ensure that they have appropriate supervision, supporting governance and systems in place.

CCQ Source: https://www.cqc.org.uk/guidance-providers/gps/gp-mythbusters/gp-mythbuster-82-physician-associates-general-practice

NHS Publication: https://www.england.nhs.uk/long-read/ensuring-safe-and-effective-integration-of-physician-associates-into-general-practice-teams-through-good-practice/

On 24 June, the Royal College of General Practitioners (RCGP) stated that general practices should stop recruiting physician associates (PAs) immediately until regulation and scope of practice guidance are finalised.

Source : https://www.bmj.com/content/385/bmj.q1376.full

A lot of attention has been placed on the role of the PA due to the public's confusion over physician associates working in the NHS and concern that hospitals and GP surgeries are deploying “doctors on the cheap” to treat patients.

Read more here: https://www.theguardian.com/society/2023/dec/13/public-confused-over-physician-associates-working-in-nhs-research-finds

🎯 The action here is to review your supervision measures.

6. How to improve care navigation in general practice

A key part of the PCN DES 24/ 25 is implementing modern general practice. To support the facilitation of transformation in your network, the guide How to Improve Care Navigation in General Practice is for you.

The guide was originally published on the 7 May, 2024 and updated on 12 June, 2024 ( at the time this blog was released).

This in-depth guide covers the modern general practice change model and walks you step by step through the care navigation process.

1. Understand

• demand and capacity

• avoidable appointments

• key measures 

• starting point.

2. Design

• care navigation flow

• care navigation protocol

• create a directory of services

• training. 

3. Go-live

• structured information gathering

• re-design of appointment book

• digitally enhanced process

• testing/implementation plan

• communications strategy.

4. Measure and improve

• evaluating success

• sustainability planning

• automation.

🎯 The guide can be found here: https://www.england.nhs.uk/long-read/how-to-improve-care-navigation-in-general-practice/#introduction and is a must-read for digital and transformation leads.

7. Capacity and Access: "Is it worth moving all practices to total triage to claim the faster care navigation element?"

This was a question recently posed in the primary care network facebook group.

The context:

The guidance states that the Local Capacity and Access Improvement Payment (CAIP) focuses specifically on implementing the following three domains of the Modern General Practice Access model:

• Better digital telephony

• Simpler online requests

• Faster care navigation, assessment and response
  

When it comes to simpler online requests, NHSE would like to see:

• Online consultation (OC) available for patients to make administrative and clinical requests, at least during core hours.
  

• A consistent approach to care navigation and triage so that there is parity between online, face-to-face, and telephone access.

There guidance can be found here: https://www.england.nhs.uk/wp-content/uploads/2024/03/PRN01035_iv_-network-contract-DES_part-b-guidance-non-clinical_april-2024-version-2.pdf

What is total triage?

‘Total triage’ is a system of triage in which patients provide information – and are triaged – before any appointment is booked (if one is booked at all).

This system should enable GP surgeries to meet patients' needs outside of appointments and prioritise their limited capacity to support those most in need of care.

🤔Are online triage and total triage the same? It depends on who you ask.

"Is it worth moving all practices to total triage to claim the faster care navigation element?"

If the will, desire, and shared vision beyond the CAIP payment is there, and you see the attached payment as a bonus, absolutely go for it. However, if you do not have the dedicated resources to facilitate implementation and you want uniform adoption, don't do this purely for the money.

I recently attended the LMC Conference in Wessex, and in the presentation given by Jenny Partridge, who works for The Health Innovation Network, encouraged us to:

🎯 Invest in the transformation and not just the tech.

(There is a range of tech available, but the tech is not the starting point. Read section 6 above, and in section 1 of this blog, we link to (12 Key Questions every Primary Care Network should consider before purchasing a Digital Solution)

🎯 Be clear on the problem you are trying to solve.

🎯 Agree principles in advance.

I would also like to add.

🎯 Make time for training and peer review audits

🎯 Enlist the support of more than one clinical champion

When speaking to other networks, you may wish to add the following questions to your conversation.

1️⃣ Knowing what you know now, what would you do differently?

2️⃣ What was the most challenging part of implementation?

3️⃣ How long did it take to bed in?

4️⃣ What is working well?

5️⃣ What is not working?

6️⃣ What performance indicators are most important?

7️⃣ Where should we start?

It's worth noting that many practices and networks have embarked on this journey and have found it successful. However, it takes time, and having a shared vision is key to uniform adoption.

Check out the above guide in section 6.

8. 100% Payment for 23/24 IIF ACC-08 Indicator

Some of you may have received communication from your ICB to remind you that no payment has been calculated for the ACC-08 indicator in CQRS and will not be included in the NCD 23/24 achievement payment. It will automatically display as 0 in CQRS, and payment is to be made off-system via the ready reckoner. No further action is required for ACC-08 on CQRS.

The ACC-08 financially rewards practices and PCNs, offering patients an appointment within two weeks or less.  

Payments for 100% achievement of ACC-08 will be processed and paid to PCNs on Friday 19th July.

This announcement follows campaigning by the Institute of General Practice Management (IGPM), which highlighted serious problems with how performance was being measured using GP Appointments Data (GPAD) and that surgeries were at risk of losing thousands of pounds as a result.

We hope you found this update helpful.

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