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PCNs automatically given maximum points for appointments IIF indicator – thanks to practice manager campaign

by Rima Evans
7 June 2024

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All PCNs will be considered to have earned 100% of the points available in the access IIF indicator for 2023/24 due to problems with achievement data, NHS England has announced.

It follows campaigning by the Institute of General Practice Management (IGPM), which highlighted serious problems with how performance was being measured using GP Appointments Data (GPAD) and that surgeries were at risk of losing thousands of pounds as a result.

Indicator ACC-08 financially rewards practices and PCNs offering patients an appointment witin two weeks or less.  To meet the target, which carried a maximum of 71 points, practices had to deliver timely appointments in eight categories including acute consultations, routine consultations, home visits and walk-ins.

They were also required to record data on appointment types, ‘mapping’ the slots that fit within the eight categories to measure achievement.

However, the IGPM wrote to NHS England’s Department of Finance in May alerting the commissioner to a ‘significant flaw in the appointments mapping data processing’ for GP surgeries using TPP’s SystmOne clinical system.

It meant that despite surgeries mapping categories appropriately, the information was not correctly processed for GPAD, leading to practices being told they hadn’t met the IIF targets.

For some surgeries, this represented a loss of ‘thousands of pounds’, the IGPM wrote, adding that they were being penalised ‘through no fault of their own’.

‘We have heard of practices and PCNs who poured hundreds of hours collectively in trying to understand why their position was not improving,’ it told NHS England.

The IGPM also highlighted problems for practices using other electronic patient record providers and that practices had been unaware slots ‘had been incorrectly mapped from the beginning of the financial year.’

Although the problems have since been rectified, the IGPM told NHS England surgeries were informed they still didn’t meet targets and wouldn’t receive the due payment, prompting it to formally challenge this decision under section 10.8.6 of the GP contract.

A response sent from the NHS England GP Incentives team on June 5 this week admitted that ‘GPAD will not be able to serve as a robust source of achievement data for 2023/24’.

It added that ‘the usual route to correcting data locally through the declaration process is likely to require a disproportionate amount of local effort this year, given the unique difficulties in being able to access alternative local appointment data.

‘For this reason, in 2023/24, all PCNs will be considered to have earned 100% of the points available for this indicator,’ the letter announced.

NHS England has also set out that:

  • ‘to ensure fair and proportionate payment’ for this indicator across PCNs, prevalence adjustment will be replaced with an adjustment based on PCN Adjusted Population as at 31 March 2024. ‘It would not be appropriate to apply the usual prevalence adjustment for ACC-08 as this would also rely on the GPAD data with which concerns have been raised’ the letter said.
  • So ‘accurate and timely payments for the remaining IIF indicators are able to be made’, ACC-08 will not form part of the 2023/24 CQRS achievement calculation and will not be subject to declaration. The letter said: ‘Commissioners will instead be provided with a Ready Reckoner to support the calculation of payment amounts, which will require submission by the commissioners via the PCN Contract Variation process’. NHS England said it is currently developing the Ready Reckoner and will release more details as soon as possible.

The IGPM, which worked with practice manager Steve Rudd, said it is pleased with the decision that  PCNs should receive payments for ACC-008 with 100% achievement. 

Robyn Clark, director at the IGPM and managing partner at Kingswood Medical Practice, Bristol said: ‘Issues with this indicator were raised at individual ICB level across the country in the last financial year to no avail, prompting the IGPM to take up the cause of our members nationally’.

She added: ‘The use of flawed data and a lack of clarity over correct slot mapping unnecessarily penalised practices who were working hard to achieve this access target, many of whom work to a same-day model and should have achieved near full compliance by default. 

‘As a result of this decision, PCN’s will be able to access much needed funding for this next contract year.’

Ms Clark said in future NHS England should ‘enlist the help and support of practice management when developing new indicators and initiatives’.

‘Our expertise in the running of practices and PCNs can demonstrate where these indicators are SMART, and add value’, she added.

Indicator ACC-08 was scrapped for 2024/25. There are now only two indicators within the IIF, worth around £13m for this financial year.