NHS Winter Access Fund - £250 million?!

You may have heard in the news that GPs are going to be getting a large money boost in the form of £250 million to help with the winter pressures. This hasn't been received very well by GPs and the BMA as they feel it's not enough and doesn't really solve one of the main issues in this, lack of doctors. I had a quick read through of the plan released by NHS England, and found some interesting points. You can have a full read of the plan here.

Point 13 and 14 - this explains that the £250 million Winter Access Fund will be used between November 2021 and March 2022. It's main aim is to prevent patients going to hospital. It will try do this via two methods.

1. Use the money to pay existing staff to stay longer or hire locums to work in practices / OOH. It also suggests hiring physicians like retired geriatricians to help manage the elderly this winter (though where are they finding these retired geriatricians who want to help out?).
2. Increase capacity at urgent care centres (UCC) and the 111 service. They suggest it could be an alternative to patient's own practice surgery.

Point 16 - Local Systems have until 28th October to submit their plan on how they plan to use the money. Money will be released in early November. Funding may be reduced or discontinued if you don't demonstrate improvement by mid-December.

Point 21 - NHS England will try drive adoption of cloud telephone system. This will remove the old phones in practices and allow you to use a headset at your PC, allow you to dial anonymously with your own phone or instantly dial from your clinical system. This will also allow more phone calls into and out of the practice, and allow real-time data of the phone lines e.g. real-time display of number of patients waiting talk to reception.

Point 25 - they will try change the fit note system, to try make it valid without a GP signature, and other professionals to be able to give to patients and to get hospital doctors to be able to create one for the patient. This should free up a lot of slots in primary care as we get so many enquiries about fit notes. 

Point 26 - DVLA already allow patients with epilepsy or multiple sclerosis to self-declare no change in their condition when renewing their driving licence. They hopefully will move this system to other conditions, and also allow other professions to sign them off. 

Point 27 - prior to the pandemic, GPs used to have very long appraisals where they had to write up all their 50 hours of their CPDs. During the pandemic it was frozen and then reintroduced in October 2020 in a much shorter form. This short form appraisal will continue through 2021, quite a good positive point.

Point 32, 33 and 34 - face to face (F2F) consultations seem to be a big political point with the government. They have said that practices should have a look at their level of remote and F2F consults and then reflect on this, with a deadline set for the end of October. NHS England and DHSC have asked the RCGP to create a report on the optimum level of remote and F2F consults. This should be done by the end of November. Importantly for partners, it sounds like a new QOF domain may come up regarding F2F appointments - it sounds to me that practices will be financially motivated to see patients F2F (or alternatively, financially punished for not seeing F2F). It'll be up to RCGP to decide what percentage will be acceptable. I imagine whatever number is decided, they'll be some who will be unhappy. 

Point 35 and 36 - A new real-time measure of patient reported satisfaction with general practice access is to be rolled out nationally and financially incentivised as early as April 2022. A survey will be sent to patients after a consultation and they will have to ask a few questions, which will include the surgery's ease of access. This will create a rating, and then this will likely be financially incentivised (or punished). I can only imagine this will change doctor's clinical practice knowing that the patient will give a rating after the consultation, even if it's meant to be just about access to the appointment. I can't imagine a patient will give a good rating if they came away from the consultation dissatisfied. 

Point 42 - taken verbatim from the document. All ICSs should start an immediate exercise to look at the following data and intelligence on their individual practices: 

• (i) any practice with overall appointment numbers lower (excluding COVID-19 vaccinations) than in the equivalent pre-pandemic months 
• (ii) the 20% of practices locally with the lowest level of face-to-face GP appointments – as opposed to whole practice, including appointments with other staff 
• (iii) the 20% of practices with the most significant level of 111 calls from their patients during GP hours 
• (iv) the 20% of practices with the most significant rate of A&E attendances compared to what would be expected 
• (v) The Care Quality Commission (CQC) will provide NHS England and NHS Improvement with data relating to the volume of feedback they have received at a regional and practice level; this includes concerns, complaints, whistleblowing allegations and feedback received through their ‘Give Feedback on Care’ process. 
•  local Healthwatch intelligence; and 
•  local CCG and LMC intelligence.

(ii) and (iv) are the important targets for me - maybe practices will have mandatory face to faces to make up numbers? It is very hard to stop some populations going to A&E, especially if you live very close to one, some practices may be stuck on that point. Those in the bottom 20% will have to have remedial action which may include partnering up with other practices, PCNs or Federations. No practice wants to be seen as the bottom 20%, and I imagine no patient will want to be at a bottom 20% practice. Also I wonder how Babylon - a largely remote consulting GP service do when they do relatively little F2F consults? 

This may be the biggest point of the document and possibly why so many GP leaders are against this plan. 

When this comes in, there may be a lot of changes to your GP surgery to prepare for these league tables, and it looks like this is going to a game-changer for primary care - for better or worse. 

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