Six months after the Chancellor first announced it, the ‘Delivery Plan for Recovering Access to Primary Care’ was finally published.

It is a national document which aims to solve the problem that is access to general practice.  It does this by using the preferred NHS methodology of identifying a one size fits all solution, and then trying doing everything possible to impose it across the service.

This solution is termed ‘Modern General Practice Access’.  What it is is essentially encouraging online contact with the practice using an online tool.  If anyone rings up or walks in the same tool should be used and completed by receptionist.  The forms should then be assessed by a care navigator who should direct appointments to the most appropriate service or team.

The document describes this Modern General Practice Access as having three components: better digital telephony, simpler online requests, and faster navigation, assessment and response (p20).  We have already seen the focus on these areas in the PCN DES.  Practices are all to use the NHS App, introduce digital telephony and there will also be a new group of fully funded online consultation products available from July 2023 (p25).

The model relies heavily on effective care navigation.  Those of you with medium term memories will recall this featured as a key part of the 2016 GP Forward View, which resulted in limited uptake across the service.  Nevertheless NHS England, “will invest in a new National Care Navigation Training programme for up to 6,500 staff, rolling this out from May 2023” (p26).

The problems in general practice run deeper than simply how calls are managed at 8am.  Capacity is undoubtedly a problem.  The document tries to claim that capacity has increased by 44% since 2019 (p10), but of the 34,700 additional staff that are delivering patient care 32,200 are ARRS or administrative staff.  Meanwhile the claimed number of additional GPs (an extra 2,200) includes doctors in training, and the reality is that the number of fully trained doctors has gone down. No additional capacity is provided as part of this plan (forgive my scepticism that simply writing ‘more new doctors’ actually means anything).

There is no new funding.  There is simply funding that has been ‘re-targeted’.  Bear in mind that inflation has not been funded in general practice for over 2 years, which means that at an individual practice level this is all taking place in the context of less overall funding.

There are nods to estates (‘government will update planning obligations guidance to ensure that primary care infrastructure is addressed by local planning authorities as they do for other infrastructure demands, such as education’ p33) and bureaucracy (where they are going to be “Building on the Bureaucracy Busting Concordat”!), and there is even mention of a national communications campaign.  But nothing that makes you believe anything will be any different this time.

So essentially there is no new money, no additional capacity, and nothing tangible.  There is only ‘Modern General Practice Access’ and some contractual changes.  What, then, is the plan for getting this one size fits all solution implemented across the service?

The answer to this come at the end of the document, where we get into performance management.  First, expect NHS England to hold ICBs to account for delivery (“ICBs are accountable to NHS England for the commissioning of general practice services and delivery against the contract”).  Accountability won’t stop there.

Next, a reminder that contractual and financial levers have been put in place, “To reinforce the ICB role as commissioner and in driving improvement, each element of the plan is supported by one or a combination of: (i) a new 2023/24 contract requirement; (ii) a new 2023/24 contractual incentive; (iii) reprioritised national funding; (iv) greater transparency of outcomes at system, PCN and practice level; or (v) the ability to leverage the existing standard trust contract” (p36).  This is code for, ‘we expect ICBs to manage GP contracts’.

Finally there will be ‘transformation support’, in the form of a National General Practice Improvement Programme (p38), which will include an intensive programme to “help practices in the most challenging circumstances or those that simply feel they do not have the capacity or bandwidth to plan a path towards a Modern General Practice Access approach”.  Practices will be selected for this based on “need and ICB nomination”.  It already has a remedial feel to it.

Contract and performance management appears to be the primary route of choice for implementing Modern General Practice Access.  We will have to see how that plays out.

However, even the authors do not think this is not going to solve the challenges general practice is facing.  Instead they frame Modern General Practice Access as the first step in implementing the reforms in general practice outlined by the Fuller Report.  It introduces the next steps by saying that, “Integrating primary care requires general practice to operate at a larger scale either as part of PCNs or at place level” (p42), which suggests quite a specific direction of travel.  It also says that NHS England will, “explore alternative approaches that can work alongside the partnership model and explore additional opportunities to better align clinical and financial responsibilities in primary care” (p42).

Contracts aside, this is probably the most directive document we have seen when it comes to general practice.  One fears it may be a sign of things to come.