GPs must plan to increase activity by 10% to access funding, says ICB

Exclusive GPs in London have been asked to increase ‘activity’ by at least 10% in order to access a £4m funding pot which the ICB previously promised to ‘ringfence’ for general practice.

North West London ICB asked PCNs to submit plans to improve access – as an alternative to their now-scrapped same-day hub model – in order to ‘release burden on other parts of the system’, including emergency care and 111. 

However, it confirmed this week that so far only 12 out of 44 applications for funding from PCNs have received final approval, despite a deadline to use the money by the end of March.

And now the ICB has refused to confirm that the money would only be spent on general practice, telling Pulse that the money is ‘dependant’ on successful bids from PCNs.

In response, Londonwide LMCs have raised concerns that this funding will be ‘lost to general practice altogether’ as many practices will not be able to meet the requirements in-year. The GP leaders also warned that the required 10% target ‘does not reflect that [practices] are already working flat out’.

This 10% activity boost requirement for 2024/25 funding follows the ICB’s previous controversial proposal, revealed last year by Pulse, to effectively mandate the use of same-day hubs by including them in its ‘single offer’ of enhanced services.

Under the plan, which received intense criticism from patients and GPs alike, practices would have had to commit to the full package – including the hubs – or receive none of the £75.4m funding for 2024/25.

After shelving the proposal in March last year, the ICB committed to finding a way to direct the £6.6m that was intended for the same-day hubs back into general practice.

In October, Pulse reported on uncertainty among LMC leaders about what practices will be required to do to access this funding, as well as concerns that the money could be ‘lost’ to general practice due to ICB delays. 

PCNs were first told to conduct an extensive patient engagement exercise in order to access £1.3m of funding, or 50p per weighted patient, and the ICB recently revealed that over 100,000 NWL residents responded. 

Pulse has now seen documents which reveal the requirements PCNs must meet in order to access the remaining £2 per weighted head of population – a total of £4.1m – before the end of this financial year. 

A bid template document said: ‘Funding will be allocated on an expectation that local transformation will allow a 10% uplift in activity which is likely to release burden on other parts of the system, this includes enhanced services delivered in primary care, urgent and emergency care and redirections via 111.’

The ICB told GPs that this ‘minimum’ 10% activity boost should be an improvement to ‘productivity’ by ‘increasing and improving patient contacts without necessarily increasing appointments’.

This ‘return on investment’ could be achieved by ‘improving operational processes’ or ‘changing skills mix’, and GP practices will be required to measure ‘baseline activity’ in order to prove to the ICB that an uplift is being achieved.

According to the ICB, these plans will also help practices ‘meet the access specification’ in the next financial year, which will become part of the enhanced services ‘single offer’ again. 

ICB leaders confirmed to patients last week that the 2025/26 specification is still being written, and it will go to the public board meeting in May. 

But they sought to reassure patients that the new ‘single offer’ will definitely not include implementation of same-day hubs, as they had proposed last year. 

In documents concerning the 2024/25 funding, the local commissioner stressed that all money must be spent by March 2025, leaving only a two-month period after the bid submission deadline in January. 

‘Funding will be paid in-year, although the ICB will reserve the right to claim funding back if PCNs fail to deliver agreed plans,’ a document on frequently-asked questions said.

The ICB also confirmed to Pulse that despite the delays, it will allocate ‘full-year funding’ for PCNs that have ‘demonstrated […] that delivery of activity has been ongoing since April 2024 and is continuing’.

NWL commissioners also said they had ‘held back’ some funds on the basis that ‘not all PCNs will be in a position to submit expressions of interest at this stage’. 

Out of the total £6.6m which ICB CEO Rob Hurd promised was ‘ringfenced’ for general practice and ‘will not be used for other services, there is £1.2m remaining, after accounting for the £1.3m patient engagement exercise, and £4.1m for improving access plans.

The ICB told Pulse that they are ‘still working’ out how any remaining funding should be used if the total funding pot ‘is not allocated to successful bids’ from PCNs. 

It confirmed that so far only one PCN has chosen not to submit, while 44 PCNs have applied for the funding, of which:

• 12 have been given final approval and will now get a contract and the funding;
• 6 have received ‘initial approval’, subject to further governance approval;
• 23 are being actively supported to ‘improve’ their bids and ensure they meet the requirements;
• 2 have been rejected, as they ‘do not meet the criteria at this point’;
• 1 has withdrawn.

A spokesperson for NWL ICB said: ‘NHS North West London ran a resident and staff engagement programme that sought to better understand what people felt was working well and not so well regarding access to local general practice. 

‘Following that, our PCNs have been asked to submit bids for up to £2 per weighted patient, with a view to starting the process for improving access. 

‘The bids were expected to be based upon the initial learning from the engagement. While the closing date for new submissions was 10 January, we have continued to work with PCNs who have submitted proposals to provide feedback and help shape them, with a view to wanting to support as many proposals as possible.’

They also said it is ‘essential that any bids meet the essential criteria to improve access’.

The ICB did not clarify how the remaining money will be used if there are insufficient ‘successful’ bids from PCNs.

‘We are still working within the ICB to determine how any remaining funding should be used if all of the money allocated to this work is not allocated to successful bids,’ it told Pulse.

When pressed on whether the money will still be ringfenced for general practice, as promised by the CEO, the ICB said: ‘We have always been clear that while additional funding was available to PCNs to improve access, the money being made available this year is dependent on successful cases being submitted by PCNs.’

Medical director for North West London LMC Dr Sukhpal Shergill said practices ‘now face losing £6.6m that should be spent on patients care’, and called on the ICB to provide a ‘contingency mechanism to get the money into general practice this financial year’.

He told Pulse: ‘We are now in a situation where practices are rushing around trying submit large volumes of complicated paperwork to access funds intended for use in the 2024/25 financial year only a few weeks before it ends, fearing failure to so will see this funding lost to general practice all together.

‘It is for this reason that a contingency mechanism is required for the very likely possibility that many practices cannot complete the current ICB process in-year.’

A GP in North West London, who preferred to remain anonymous, told Pulse that the requirement to boost activity by 10% was a ‘crude parameter’ and ‘runs counter to the understanding that general practice is already under strain’.

They said: ‘After the debacle of the same-day access hubs, GPs across North West London were looking forward to a renewed process where this money could have been invested in a supported way to meaningfully improve access.

‘Unfortunately, six months was spent on a small sum of money used for a protracted engagement exercise, leaving the bulk of the money unallocated until November.

‘This then required practices to jump through hoops of increasing activity, and now running the risk of not being approved, and not being used for general practice. This money should’ve been made available at a much earlier stage for practices.’