Access remains a highly contentious issue and the latest publication from NHS England regarding the 2022/23 contract updates has resulted in a wave of concern from some GPs and unhelpful headlines in the usual suspects of newspapers.

Negativity permeates a lot of what we are doing as a professional sector and in many parts of society. It is easy to look at perceived problems and often hard to focus on the positives.

Of the Clinical Directors, PCN Managers and GP partners I have discussed this with, once we spent some time assessing the impact on them and their practices, it has been evident that this change is likely to bring about a number of positive outcomes. I wanted to share this with a wider audience to hopefully improve the perception of the changes.

Is there a greater time commitment?

If you are in a practice that has never delivered the Extended Access requirement and you have limited engagement with Improved Access it may feel like an increased obligation.

In most other cases it will be the same and, in some areas, could be a reduction of time. There are areas who have been working under Improved Access at or close to 45 minutes per 1,000 patients plus the 30 minutes of Extended Access. For these areas the strict obligation will be easier to provide.

Services I am involved with have been operating on a model of 37.5 minutes and in practice we have been delivering closer to 50 minutes under Improved Access at the request of our member practices. Consequently the new combined requirement will be between 7.5 and 20 minutes less than currently provided.

Many other areas are the same, but it is essential to ensure that the time requirement is tracked on a like for like basis.

Is there sufficient funding?

The letter states that NHSE will ‘bring together, under the Network Contract DES, the two funding streams currently supporting extended access to fund a single, combined and nationally consistent access offer…’. This means that for every patient £7.44 will be available.

Currently £6 per head is commissioned by the CCG and is paid to the local provider of Improved Access. Some PCNs took responsibility for this funding and commissioned their own Improved Access in 2020, others received the service indirectly through federations.

By moving this fund into the PCNs it is arguably the first significant funding stream that can significantly improve the performance and structure of the network.

The following table provides a quick reference to the new time obligations and funding to support it:

It is important to recognise that some of this money is already being used by practices and other funding will be with federations or other third parties. The effect of moving these funds into the PCN need to be carefully considered locally so it does not destabilise other services which may be relying on top slicing these revenue streams.

Will the workload increase?

The guidance is vague and in many ways that is far better than the current requirements managed by CCGs. One of the biggest challenges with Improved Access contracts was the focus on appointments of 15 minutes. This resulted in a limiting factor which either excluded or made it very difficult to count many of the more innovative uses of the additional time.

Group consultations, tissue viability clinics and DVT management clinics were some examples that delivered excellent patient outcomes but struggled to demonstrate the appointment counting criteria.

The new requirement simply states that the time is used for ‘any general practice services’. A narrow interpretation for this could be a full suite of services but I would recommend that unless further guidelines are brought out, we use a broad interpretation. Our focus will be on delivering those general practice services which are making the biggest impact on our patient’s needs and preferences.

In some areas this may be a full range of services in others it could be a focus on cohorts of patients. I am aware of a PCN who focuses on weekend clinics for the elderly as they discovered it was the best time for family and carers to help the patient travel to the practice.

This type of patient focused service modelling is at the heart of the original PCN concept and this is an opportunity to start shaping support around them. This is the first requirement in the preparation stages outlined in the guidance.

Sharing the workload between practices by developing shared services across the PCN should improve the levels of demand on practices if managed correctly.

Will much change?

For many practices probably not. Enhanced Access is not significantly different than the current arrangement and as argued above it provides new opportunities to PCNs in terms of service design, improved funding and integrating workloads.

The option remains for PCNs to take responsibility for the funding but to agree with practices and with other providers to continue providing existing levels of cover and services. As long as these meet the minimum requirements and the parties are happy with this approach this allows continuity whilst giving more financial control to the PCNs.

This may well be the stop-gap position whilst a longer term review and service redesign process is instigated by the practices to shape services in the future.

If you are in an area with poor service availability with current Improved Access providers, this situation should improve as you take greater control. There are also areas where the CCG top-sliced the £6 figure, so in these areas the full amount will be made available to practices for the first time.

There will be exceptions to this principle but in general this is a change which should be seen from a positive, pro-GP perspective.

Next Steps

We have until October before the new requirements go-live and first drafts of the Enhanced Access Plans need to be submitted by 31 July 2022. This time will fly by quickly so it is better to get started at the earliest opportunity.

It is likely that these plans will be subject to a form of localised template but in the meantime PCN teams can look at current arrangements, discuss with the practices how they want to manage the transition from the current service and speak with your current Extended Access providers.

You can also engage with your patients at the earliest opportunity. Use different data sources to build a picture of the changes that are most likely to improve services as a whole.

This information will be a great starting point to manage the transition to the new specification and you may be surprised about how little change is needed. For others this is a chance to start implementing some of those longer-term aspirations you have had and to start those service improvements which have been delayed in recent years due to the pandemic or a lack of funding.

It can be hard at times to be optimistic, but I am convinced from the discussions I have had over the past few days that this is a change that should be embraced rather than feared.