Standing back from the Delivery Plan for Recovering Access to Primary Care: key takeaways

On 9 May 2023 NHS England and the Department of Health and Social Care issued their plan for recovering access to primary care. The plan builds on Dr Claire Fuller’s report, Next steps for integrating primary care and forms part of the Government’s commitment to improve access to general practice outlined in its Autumn statement. It also builds on the GP contract changes announced in March 2023.

The plan running to 46 pages sets out measures across four key pillars from empowering patients, implementing modern GP access, building capacity, and cutting bureaucracy – page two provides an overview of all 14 commitments.

We provide a summary of the key takeaways relevant to general practice, community pharmacy providers, NHS Trusts / Foundation Trusts (or those supporting them) as well as Integrated Care Boards (ICBs).

1. The plan seeks to end the situation where patients are asked to call back another day to book an appointment.

2. It seeks a position where, on the day of contact, patients are made aware of how their request will be managed setting three groups/ categories:

• If their need is clinically urgent it should be assessed on the same day by a telephone or a physical/ remote face to face appointment (anything received in the afternoon they may be assessed the next day unless that’s clinically inappropriate).
• If their need is not urgent, but it requires a telephone or face to face appointment, that must be arranged within two weeks.
• If appropriate patients can be signposted to self-care or local services.

3. They will seek to “empower” patients. They will do this by expanding the use of the NHS App (for patient record, repeat prescriptions, reading practice messages and managing routine appointments), by increasing self-directed referrals (albeit that’s a work in progress) and expand community pharmacy services.

They are looking at introducing a “Pharmacy First” service for patients where pharmacists will have the ability to:

• supply prescription only medicines under the Patient Group Directions (which allow medicines to be supplied to patients who meet certain criteria after having a consultation with their pharmacist); and
• treat sinusitis, sore throat, earache, infected insect bites, impetigo, shingles and uncomplicated urinary tract infections in women.

Beyond this they will have an expanded role in blood pressure checks and oral contraceptives.

To support all of this (and to join up general practice and community pharmacy) they intend to invest in improving the digital infrastructure so there is an “interoperable digital solution” which streamlines referrals, provides additional access to clinical information from GP records and shares structured updates from the pharmacist back to the GP practice.

4. They will provide funding to achieve what they call the “Modern General Practice Access” illustrated on page 20 of the plan.

To support this, they will fund:

• The transition to digital telephony (which includes queuing, call-back and call routing and integrates with current systems) must be in place by all general practice by the end of 2025.
• High quality online consultation, messaging and booking tools for general practice by changing the Digital Care Services catalogues and introducing a new group of funded products (Digital Pathways Lot) which will be procured through the ICB.
• Higher quality digital tools to support the rapid assessment required at the first point of contact.

5. They will “build capacity”. This includes funding larger multi-disciplinary teams (recognising GPs are like unicorn tears) via the ARRS scheme that will include funding for a “digital and transformation lead” (who will help practices move to new digital tools and support the Modern General Practice Access) and advanced clinical practitioner nurses.

6. In recognition of the need for investment in general practice, they will look at how general practice can be better supported under planning policy/ guidance. Before this, they are seeking to ensure that ICBs have a say on larger development sites that create a need for extra primary care capacity. Ultimately it looks like, with a greater say, ICBs will have a greater call on any Infrastructure Levy charged to developers.

7. They will look to cut bureaucracy by ensuring that (where necessary) onward referrals are made by secondary care, complete discharges are made by hospital trusts/foundation trusts (with detailed fit notes with clear actions for the patient and general practice), trusts/ foundation trusts have their own call/ recall system and a single pathway is created between primary and secondary care.

Do get in touch if you would like support with implementation of the GP contract changes and the recovery plan.