NHS England needs to recognise that GP practices are not a ‘limitless service’, the Institute of General Practice Management (IGPM) has said following the release of a new GP contract letter this week.
The contract imposed on GPs by NHS England, and which was released on Monday (6 March), set out changes for 2023/24, including various stipulations about access to general practice, but mentioned no extra funding.
The new requirements set out that practices must offer patients an ‘assessment of need’ on first contact and are no longer able to request that they contact the practice at a later time.
IGPM said it had ‘concerns’ regarding the contract and was ‘bitterly disappointed’ about the lack of funding uplift.
‘NHSE must recognise that GP practices are not a limitless service,’ said Robyn Clark, director of the IGPM. ‘Whilst an assessment of need can occur, if there is not a corresponding appointment available, what are practices to do? Telling patients to call back at another time is a last resort for staff.’
She added that practice managers ‘recognise’ the difficulties that patients experience accessing appointments.
However, she added ‘in the majority of cases the problem lies not with how the practice structures its appointment system, but in the inability to keep up with rising demand’.
‘This is more directly as a result of reduced staffing, higher turnover, pressures on estates and a backlog of problems cause by delays for treatment in other parts of the NHS,’ Ms Clark explained.
She added that there was little information from NHS England about how ‘success’ regarding access and patient experience will be assessed and urged for more detail on that.
Ms Clark also queried whether practices may ‘be penalised’ when they prioritise patient ‘need’ over ‘want’.
‘Quite often what a patient needs versus what they want are very different things, and practices receive backlash where the want is not addressed, regardless of whether the need is. Are practices to be penalised in these circumstances?’
Lack of funding
The IGPM also expressed disappointment that issues raised by the Health and Social Care Select Committee’s report on the future of general practice were not addressed, including core contract investment and support for the independent contractor model.
With costs increasing for practices, Ms Clark said they were concerned for GP practices that may need to make staffing cuts to ‘stay afloat’, and that this ‘will not help improve access’.
‘Stressed staff who are overworked do not provide a better patient experience. These things need investment to support them, and we are bitterly disappointed to see that the core contract value is not being uplifted to support practices to achieve this,’ said Ms Clark.
However, the institute added it recognised and ‘appreciated’ changes to some QOF clinical indicators, including around childhood vaccination and immunisations, as they are currently ‘unachievable and unrealistic targets’.
Under the new contract, target thresholds for three childhood immunisation indicators VI001, VI002 and VI003 have been lowered. From April, the ‘clawback’ of item of service fees when practices fail to meet certain targets will also be removed.