Every year the powers that be produce “operating guidance” for the NHS for the forthcoming year. It is published at around Christmas time (happy Christmas…) so that NHS organisations and Integrated Care System (ICS) partners can build the guidance into their plans for the forthcoming year.  True to form, this year the guidance was published on 23^rd December.  What implications does it have for general practice?

General practice features right from the outset.  The immediate priority for the NHS is to “recover our core services and productivity” and along with ambulance, A&E and elective waits the document prioritises “make it easier for people to access primary care services, particularly general practice” (p3).  No surprise that it is GP access that takes centre stage.

There are three specific general practice targets (p7):

• Make it easier for people to contact a GP practice, including by supporting general practice to ensure that everyone who needs an appointment with their GP practice gets one within two weeks and those who contact their practice urgently are assessed the same or next day according to clinical need
• Continue on the trajectory to deliver 50 million more appointments in general practice by the end of March 2024
• Continue to recruit 26,000 Additional Roles Reimbursement Scheme (ARRS) roles by the end of March 2024

The guidance further notes that an ominously titled “general practice access recovery plan” is being produced and will need to be implemented when published.  It certainly feels like this document will contain more of the actual detail of what systems are expected to impose on practices next year.

There is an annex that, “sets out the key evidence based actions that will help deliver the objectives set out above and the resources being made available to support this” (p8).  I looked forward to turning the page and finding out what these were, but was somewhat deflated to discover that for general practice these are to, “ensure people can more easily contact their GP practice (by phone, NHS App, NHS111 or online)” and “transfer lower acuity care away from both general practice and NHS 111 by increasing pharmacy participation in the Community Pharmacist Consultation Service”.

Disappointing, but not surprising.  Things don’t improve when it comes to the money.  Essentially there is no new money.  Instead, there is an overall 2.2% efficiency target.  Systems are expected to pay acute providers payment for activity performed (no block contracts), and every ICS has to come up with a balanced plan.  For general practice we are told funding has already been agreed in the existing 5 year deal (so don’t expect any more), and if local systems have to stick with payment by results there is very little possibility of any new local investment into primary care.

The challenge when it comes to general practice is that the Operating Framework is always published before the GP contract has been finalised.  In the only nod to Fuller (the Health and Social Care Committee Inquiry report is ignored completely) the document states, “Once the 2023/24 contract negotiations have concluded, we will also publish the themes we are looking to engage with the profession on that could take a significant step towards making general practice more attractive and sustainable and able to deliver the vision outlined in the Fuller Stocktake, including continuity of care for those who need it. The output from this engagement will then inform the negotiations for the 2024/25 contract.” (p10).

This leaves us basically where we thought we were, i.e. that the NHS has no intention of doing anything other than imposing year 5 of the 2019 deal for 23/24, and anything new will have to wait for the next contract that will start in 2024.

All of this is hugely depressing given the challenges the service is experiencing.  Any hopes that the Health and Social Care Select Committee Report would mark a shift of emphasis from access towards continuity have been firmly dashed.  Even the mention of continuity of care feels like it has been done as a concession to the profession, as a subtext to the “real” NHS agenda of GP access.

We will wait and see what (if anything) comes out of the contract negotiations, and what horrors await in the ‘access recovery plan’, but all signs are already pointing to a very difficult 2023 for general practice.