Each year the NHS publishes planning guidance.  This year is no different, and on Christmas Eve (happy Christmas everybody…) true to form the NHS published “2022/23 Priorities and Operational Planning Guidance”.   It outlines for the NHS what needs to be achieved in the year ahead.

While it is not a document specifically aimed at general practice (rather it is aimed at the NHS as a whole), it provides an interesting perspective on how general practice is viewed within the system, what the priorities for general practice are likely to be, and gives some indication as to what will feature in next year’s GP contract.

The document sets 10 priorities for the NHS.  General Practice explicitly features in one of them, namely to, “Improve timely access to primary care – maximising the impact of the investment and Primary Care Networks (PCNs) to expand capacity, increase the number of appointments available and drive integrated working at neighbourhood and place level” (p6).

So first off, in case anyone thought there might be some national backing off from the October guidance that generated such a backlash (including a mandate for national strike action for the GPC), there is a clear reinforcement of the need for the paper to be implemented (“In line with the principles outlined in the October 2021 plan, systems are asked to support the continued delivery of good quality access to general practice through increasing and optimising capacity, addressing variation and spreading good practice” p25).

More interesting is the newer theme that pervades the text around integration.  Integrated Care Systems go live next year, although this document confirms that this will now happen on July 1^st not April 1^st to allow time for the bill to pass through parliament.  Systems are exhorted to, “maximise the impact of their investment in primary medical care and PCNs with the aim of driving and supporting integrated working at neighbourhood and place level.  Systems are asked to look for opportunities to support integration between community services and PCNs” p24.  The review of PCNs will be reporting in March, and I wouldn’t be surprised if it marks a shift of PCNs away from ownership solely by practices.

Systems will also be judged by the extent to which their PCNs have made use of their ARRS allocation, and are also asked to support employment models across organisations, “Systems are expected to support their PCNs to have in place their share of the 20,500 FTE PCN roles by the end of 22/23 and to work to implement shared employment models” (p24).  It is interesting that underneath the opportunity for PCNs to use the ARRS funds there is a top down pressure on local systems for all the money to be spent.  Indeed, the rationale used is not to support general practice, but “to support the creation of multidisciplinary teams” (p9).

There is a further notable nuance that PCNs (not practices) are treated as the unit of general practice in the guidance.  It claims that there will be, “ a suite of national GP recruitment and retention initiatives to enable systems to support their PCNs (not practices) to expand their GP workforce and make full use of the digital locum pool” (p9).  We also won’t hold our breath in anticipation of all the same additional GPs we have been promised for the last 5 years…

There are two other major items of note for general practice in the guidance.  The first is the big push in the guidance on the roll out of virtual wards.  The ambition set is that by the end of 2023 there will be 40-50 virtual wards per 100,000 population.  These are to be based on a partnership between secondary, community, primary and mental health services, and they “should only be used for patients who would otherwise be admitted to an NHS acute hospital bed or facilitate early discharge” p21.  £200M in 22/23 and £250M in 23/24 is being made available to develop these wards, although given the numbers of wards expected how they will work is a mystery, as my back of the envelope calculation gives each ward less than £10,000 to operate.

The other item of note is a promised new IIF indicator for PCNs to incentivise contributions to a minimum of 2 million additional pharmacy consultation appointments in 2022/23.  According to the guidance (p25) this will move “more than 15 million appointments out of general practice”!

Overall, the main takeaway is the pressure that will come around ‘integration’ – PCNs and PCN staff to work across organisations, multidisciplinary teams, multi-organisational virtual wards, joint working with pharmacies, and (of course) new integrated care systems in charge of everything.  What could possibly go wrong?