NHS England implements GP winter plan

An NHS England letter said it had to take action ahead of winter to boost capacity and reduce workload and admin. The steps include giving primary care networks (PCNs) greater flexibility to scale up additional roles in primary care.

An integrated care board (ICB) framework for supporting general practice will rapidly assess the needs of practices and PCNs. It will also identify where additional capital – should it be released to ICBs later this year alongside system development funding (SDF) – could make a difference to primary care delivery and resilience this winter.

Changes to contracts will extend the flexibility to employ into the additional roles reimbursement scheme (ARRS), which will include the addition of GP assistants, to reduce the administrative burden on GPs, and digital and transformation leads, who will optimise digital tools to deliver transformation.

Other changes will see PCNs receive additional funding following the abolition or deferral of four investment and impact fund indicators, while the thresholds for two further indicators will be reduced to make them easier to achieve.

The guidance was published as the RCGP warned that urgent action must be taken to persuade GPs to stay in the NHS. Its report, Fit for the future: retaining the GP workforce, said retention should be as big a priority as recruiting new family doctors.

High levels of stress and burnout, pension rules, family and caring responsibilities, and recruitment issues, particularly in deprived areas, could lead to GPs leaving the profession earlier than planned, it said.

In England, the number of qualified full-time equivalent GPs fell from more than 29,300 in September 2015 to 27,500 in August this year. The royal college said that each GP is looking after 15% more patients on average than in 2015. A recent RCGP survey of GPs and trainees across the UK said almost 22,000 planned to leave in the next five years.

Retention schemes

The college called on the NHS to provide £150m a year to back local and national retention schemes. It insisted on better career support for early career GPs, action to address unsustainable workload and the expansion of multidisciplinary teams, and better communication of the role of GPs and other primary care staff.

RCGP chair Martin Marshall (pictured) said many GPs were suffering burnout and exhaustion. A recent college survey suggested almost a quarter of GPs across the UK were so stressed that they felt they couldn’t cope most days or every day. More than 68% of respondents were concerned that they don’t have enough time to properly assess their patients.

‘While there has been good progress to encourage newly qualified doctors into the profession, if more GPs are leaving than joining, we’re fighting a losing battle. We’re stuck in a vicious cycle of an understaffed and under-resourced service that is unable to sustainably meet the needs of its patients,’ Professor Marshall said.

‘Urgent action is needed to break this cycle. The government must make GP retention a priority.’

NHS England guidance set out more details on system development funding (SDF) and additional roles in primary care to support practices this winter and beyond.

The SDF includes support for GP transformation and for nine workforce programmes.

The GP transformational support fund – created by merging the previous digital first and PCN development funds – is worth £78m in 2022/23. Initial fair shares allocations were handed out in the first quarter, with the remainder allocated in Q2 and Q3. The amounts and timing will be confirmed following discussions between ICSs and their regional teams on spending plans.

Iterative discussions will be held over the rest of the financial year on delivery and to boost a shared understanding of the use and impact of the fund, the letter added. Some spending will be made at regional level.

The funding should be used to: support staff skills and capabilities; improve working practices, reduce unwarranted variation and increase operational efficiency; and push forward integrated working.

It should embed new working practices and not be spent directly on equipment, software or licences. Examples include ensuring triage processes supported by digital access routes work well, and deploying business intelligence tools to boost understanding of demand and capacity and using this understanding to improve services.

Transformation support also includes general practice resilience funding (£8m in 2022/23). The fund aims to support practices to become more sustainable.

The nine SDF workforce programmes include the scheme to help GPs who are new to a general practice partnership, international GP recruitment, flexible staffing pools, and the additional roles reimbursement scheme (ARRS).

ARRS, which receives the lion’s share of the funding to ICBs, provides funding for 26,000 extra primary care posts, allowing PCNs to create multidisciplinary teams to suit local needs. There will be £634m available this financial year with a further £393m held centrally. Each integrated care board’s share can be released when needed subject to regional and national approvals.

It is expected the funding will create 20,570 additional roles by the end of this financial year, rising to 26,000 by the end of 2023/24. ICBs should provide effective support for PCNs to recruit, embed and retain the new roles.

GP IT funding covers areas such as the futures framework core funding for GP IT systems, and primary care estates development. Some of the funds, including £15m for online consultation software, is part of SDF, though in future funding will be sourced from GP IT.

Baseline GP IT funding for 2022/23 is almost £257m, which has been included in ICB core baselines.