Whilst there is not a whole lot of change in the GP contract for next year, there are a few things that are different and worth watching out for.  All the headlines have (rightly) been about the lack of any additional funding, but that doesn’t mean practices and PCNs should not pay attention to some of the changes that have been squeezed in.  I highlight 3 things it would be wise to keep an eye on below.

1. PCNs to Performance Manage Practices?

One of the changes presented in this year’s PCN DES is that PCN Clinical Directors are now to determine whether the PCN member practices have met the key components of Modern General Practice Access.  It states:

“10.4A.3. The PCN Clinical Director must, prior to 31 March 2025, apply the assessment criteria and determine whether each improvement has been achieved (i.e. whether all assessment criteria for an improvement has been met). When applying the assessment criteria, the PCN Clinical Director must apply the criteria across all Core Network Practices of the PCN.”

This potentially puts Clinical Directors in a tricky position.  Practices will be pushing for them to claim the funding as early as possible, and yet it is down to the Clinical Director to determine whether the practices are eligible.  Without working this through carefully with practices (e.g. how will the PCN make the decision that practices are eligible?) the Clinical Director could unwittingly end up being the performance manager of practices.

2. How will the Digital Telephony data be used?

Alarm bells are also ringing with the new requirement outlined in the contract letter for practices to provide digital telephony data from October:

“In 2024/25 the GP Contract will be amended to require practices to provide data on eight metrics through a national data extraction, for use by PCN Clinical Directors, ICBs and NHS England.  These eight metrics are:

1. call volumes
2. calls abandoned
3. call times to answer
4. missed call volumes
5. wait time before call abandoned
6. call backs requested
7. call backs made
8. average call length time”

While the claim is that this will be used by NHS England and ICBs to “support service improvement and planning” it would not be a huge surprise if the system came down hard on outliers.  What will be interesting will be whether this pressure is exerted on practices directly, or whether it comes via the PCN.

In fact, the subsequent Update and Actions for 24/25 to the delivery plan for recovering access to primary care states,

“Our goals for 2024/25 are … for PCNs to review the key telephony metrics across their practices (including number of calls, average wait, abandonment time, average call length) to support quality improvement in demand management and planning of care navigation. …Separately, we plan to share data on the number of calls to 111 in core hours with PCN clinical directors to support quality improvement.”

If “support quality improvement” really means “performance manage” (because that is how NHS England operates), then pressure on PCN CDs to performance manage their practices really does look like it could become a theme for the year ahead.

3. Neighbourhood Teams: PCN-shaped or community services shaped?

In the 2024/25 Planning Guidance, that was finally released at the end of March, it was no surprise to find access as the priority for general practice.  However, integrated neighbourhood teams also feature, and the guidance states,

“As a step to building integrated neighbourhood teams and to support the integration of primary care and community services, we ask systems to help improve the alignment of relevant community services to the primary care network footprint.” p18

There is a heavy scepticism amongst some as to whether in reality this will mean PCN footprints being forced to align to community service footprints (as opposed to vice versa).  Certainly it is something to watch out for, as the guidance is written with an apparent primacy of the PCN footprint.

But this is not the end of it.  The last page of the planning guidance states,

“We will work with ICBs to ensure that each system has a plan that shows over 3 years how primary care and community organisations will work to shape integrated neighbourhood teams.” p35

While at present integrated neighbourhood teams appear to be random joint working initiatives looking at specific patient cohorts e.g. frail elderly, patients with diabetes etc, the plan for the future seems to be something more substantial.  “Integrated neighbourhood teams” may actually be a euphemism for general practice and community services operating as part of the same organisation, or at least a structured partnership between the two.  Aligning PCNs and community teams looks like it may be the first step on that journey.