Changes introduced under the new GP contract will worsen workload for practices as they try to recover Covid backlogs, practice managers have said.
Published earlier this week, NHS England’s updates to the 2022/23 contract set out several new requirements that practice managers have described as posing ‘logistical, financial and staff’ challenges which are ‘not feasible or sustainable’.
This includes planning for practices in England’s primary care networks (PCNs) to open from 9am to 5pm on Saturdays from October, and replacing the requirement to list at least 25% of appointments for online booking with ‘a more targeted’ approach.
However, practice managers have warned NHSE that staff are feeling burnt out from the last two years, with willingness to work beyond contracted hours at ‘an all-time-low’.
The Institute of General Practice Management (IGPM) explained that staffing those additional hours would therefore require moving sessions from within ‘core hours’, which would not increase the overall number of appointments.
It added that enforcing weekend working could risk pushing a greater number of staff out of surgeries, with many clinicians choosing to work general practice as the hours support their work/life balance.
Managers were also concerned by the lack of clarity around whether the infrastructure to provide routine services – such as sample collection or IT support – will be in place in the new extended hours.
This comes after the BMA warned that practices are currently offering more appointments ‘than they can safely accommodate’.
Who has responsibility for systems?
According to the contract update, PCNs will be required to provide ‘bookable appointments during the Network Standard Hours which are available to the PCNs registered patients’.
However, the IGPM flagged that it is the individual practices which hold registered patients, not the PCN.
‘Our clinical systems are separate and whilst cross-organisational booking is possible in some areas, it is a laborious process that often results in IT failure,’ it said.
The revised GP contract states that practices must make ‘same day online booking for available routine appointments where no triage is required’ up until as close to the slot time as possible.
There is currently no solution that would allow a non-registered patient to do this, the IGPM suggested, adding that this would mean not providing access for patients registered with another practice in the network.
It also said that the implication is that PCNs will be responsible for ensuring systems allow for this, despite most IT infrastructure being headed by the CCG or CSU.
Additionally, the new online booking requirements do not acknowledge that most practices manage this process differently, the IGPM said.
It also does not account for the fact that patients may book into the wrong appointment type, leading to either wasted consultations or added admin spent verifying lists.
NHSE must support staff
The Institute also urged NHSE reconsider elements of the plan to ensure staff feel ‘supported, engaged with and resilient’.
While it welcomed the £280m funding for the additional roles reimbursement scheme (ARRS), it warned that this is at the expense of an increase to the global sum, which would allow recruitment to equally important roles not covered under the scheme.
Similarly, many practices are located within CCG areas that see ‘considerable’ underspend in the ARRS budget, with not clarity on where this gets reinvested.
It said: ‘We are committed to returning to business-as-usual as much as possible, but also need to emphasise that the pandemic has in many areas been detrimental to our ability to retain and recruit new staff, safely manage our estate in a way that maximises patient access and be able to manage the expectations and demands of patients.’
Management in Practice’s sister title, Pulse, was told this week that the GPC is considering its ‘next steps’ as a negotiator has called for a vote of ‘no confidence’ in NHSE leadership.
However, NHS England’s primary care medical director has today said negotiators were ‘consulted’ on the changes to the contract.