GP practices are struggling to reap the benefits of NHS England’s recovery plan, with almost half of ICBs reporting low uptake of the national ‘transformation’ training programme.
The General Practice Improvement Programme (GPIP), introduced as part of the primary care recovery plan in May, aims to improve access for up to 1,500 practices within two years.
Sign up opened in July, but at least 17 ICBs reported issues with GPIP participation in their autumn updates on recovery plan progress.
Many cited barriers such as GP practices lacking capacity and being unable to commit to weeks of training, while others said the lack of central funding was deterring practices from signing up.
And the RCGP warned that workload pressures mean many practices ‘simply don’t have enough time’ to receive additional training and support sessions.
However, NHS England said that ‘more than 1,200 practices have so far benefited from the nationally funded support programme’, but it confirmed that this includes the ‘universal’ part of the GPIP, which is open to all practices and comprises only online webinars rather than tailored training.
North Central London ICB reported ‘low uptake’ of both GPIP and previous programmes, with health leaders saying they ‘continue to hear that anecdotally practices are uncertain of the value of participating’.
‘We have fed back to the national programme team that it would be very helpful to have evidence of impact for practices that have previously participated in the programme, to share,’ the updated added.
Building on the previous Accelerate programme, the scheme has separate intermediate and intensive levels which last for 13 and 26 weeks respectively.
NHS England describes GPIP as a ‘hands-on’ package of support for practices to transition to its vision of ‘modern general practice access’.
This means practices should be able to better align capacity with demand, and see to all patient needs via telephone or online access.
Training includes facilitated in-person sessions, and for the intensive offer practices receive on-site support.
But this level of commitment seems to be an issue for practices who may be struggling just to stay afloat.
North West London health leaders told their public board: ‘We have fed back to the national team that practices are finding the time required to complete the national programmes a barrier.’
The ICB reported 14 practices currently undertaking or having completed in GPIP, with four having withdrawn. This means less than 4% of practices in the area have participated.
Hampshire and Isle of Wight ICB pointed out that the national support runs the risk of missing those practices most in need of help.
‘Often the practices who would benefit most from support offers are those least equipped to be able to commit to the time and leadership requirements and therefore there is a risk they do not sign up,’ the board report said.
Nottingham and Nottinghamshire ICB highlighted that ‘taking staff out of practices, especially during the winter months, can be a challenge’.
Health leaders in this area also pointed to workforce constraints: ‘Pressures of workforce availability impact on staff capacity to invest in development opportunities.’
In South Yorkshire, where less than 4% of GP practices had signed up to the programme, the ICB said the main barrier was staff capacity.
Their update said: ‘There has been limited take up across SY with only 6 practices enrolled so far.
‘The programme requires a significant amount of input from practices which is the main obstacle as they struggle to free up sufficient capacity to allow the “head space” to engage fully.’
As well as capacity problems, there are other logistical barriers to participation for some practices.
To be eligible for GPIP, practices must have gone live with digital telephony, which was part of this year’s GP contract.
However, ICBs said this eligibility criteria has prevented some practices from joining the programme.
Somerset ICB said they ‘have several practices that wish to enrol but are unable to do so until they have migrated across’, and Shropshire, Telford and Wrekin ICB said the timing of GPIP is ‘challenging’ with ‘17 practices unable to engage’ because of the enrolment criteria.
Practices do not receive any direct funding for participating, which has deterred some from signing up.
Black Country ICB said: ‘Historically, practices have received funding for participation on the schemes. This year funding to enable the release of staff is to be identified and provided by the released IIF funds […] Unfortunately, this lack of central funding has affected practice access.’
RCGP chair Professor Kamila Hawthorne said the ICB reports on low uptake show that ‘we can’t escape fundamental shortfalls in funding and longstanding failures in workforce planning’.
‘It‘s both ironic and concerning to hear that an initiative introduced to assist GP teams to improve patient access can’t be fully utilised because of the fundamental shortfalls we’re facing in workforce and capacity. It’s a real Catch-22 situation,’ she said.
Professor Hawthorne added: ‘GPs and other team members are working above and beyond to ensure they meet the growing demand for patient care, but this means many simply don’t have enough time to receive additional training and support sessions.’
In order for general practice to improve, she said GPs ‘need to see resources and time set aside for digital transformation’.
An NHS spokesperson said: ‘More than 1,200 practices have so far benefited from the nationally funded support programme, which includes additional funding via the IIF and transition cover and transformation support funding to help practices participate.
‘We continue to work with ICBs to encourage practices to take up the opportunity for improvement support, whether through the nationally funded programme or more local programmes that support general practice and their patients.’
Earlier this month, it was reported that only three ICBs met NHS England’s GP recovery plan target to expand self-referral pathways by the end of September.
In November, amid winter and industrial action pressures, NHS England instructed ICBs to prioritise ‘financial balance’, with the GP recovery plan among a host of targets being deprioritised.
A version of this story first appeared on our sister publication Pulse.
