North West London ICB has asked GP practices to come up with their own plans to improve access in order to access funding that had been tied to now-scrapped same-day hubs.
But LMC leaders in North West London expressed concern that over £5m of the funding for access improvement could be ‘lost’ to general practice due to ICB delays.
Pulse exclusively revealed in February that NWL ICB was planning to effectively mandate same-day hubs by including them in its ‘single offer’ of enhanced services, which means practices have to commit to the full package or receive none of the funding.
In March, when NWL ICB was forced to scrap the controversial plans – due to intense resistance from both patients and GPs – it committed to finding a way to direct the £6.6m that was to be used for the hubs back into general practice.
But local GP leaders fear that some of this this money may not end up being used in this way due to a ‘lack of clarity’ about what PCNs need to do.
The ICB presented a ‘refreshed’ access improvement plan at a local health scrutiny committee meeting yesterday, where it recognised its initial plans had been ‘not well received’.
The new plan will still see GP practices required to sign up to the full ‘single offer’ in order to receive funding from the wider bundle of enhanced services in 2025/26.
But rather than imposing a particular model of same-day access, the ICB wants the PCNs to ‘co-produce their access models with their member practices and patients’.
The first step towards this is a survey sent to all patients and staff members in the area, for which PCNs are receiving funding of 50p per weighted patient, which makes up £1.3m of the total £6.6m available until the end of this financial year.
NWL LMC leaders recognised that the survey results ‘could provide practices with meaningful insights’ but raised concerns around the ‘project timelines’ and workload for practices.
They also said there is a ‘lack of clarity’ about the next phase of the ICB’s programme to improve access, noting that the plan for the remaining £2 per patient has not been finalised or communicated to practices.
A briefing pack for yesterday’s scrutiny committee meeting said the next stage following the survey depends upon gaining approval for a business case ‘enabling each PCN area to make a case for funding to the ICB, to support plans they might have for improving access’.
In order to access further funding, PCNs will need to submit plans for improving access which show ‘return on investment’ and which are based on patient views.
The ICB document continued: ‘Those areas that have previously implemented same-day models may look to build on and develop these further or decide to focus on something different.
‘Each area will, however, be expected to incrementally trial and test their plans, to involve patients in developing and shaping their plans, to continuously evolve and improve what they are doing and work to organically improve patient satisfaction with access.’
NWL LMC network chair Dr Chaand Nagpaul told Pulse that the LMC has received ‘considerable feedback’ from PCNs about the ‘real lack of clarity’ for the specification going forward and whether all the funding pot will be used.
He said: ‘At the moment, what we are quite troubled with is that it’s now October and the ICB have taken such a long while in developing this “engagement” stage – which is 50p per head – leaving the remaining £2 per head, the total £5m, unaccounted for. They have not actually got any plans yet.’
In yesterday’s meeting, Dr Nagpaul called on the ICB to provide assurances on this: ‘I just want clarity on behalf of GP practices and the general population […] that whatever is not used is kept aside for the use in general practice, for access and this scheme, separate to the £6.6m that comes on stream in April 2025.
‘We do not want to see money lost to general practice because of the delay that’s taking place at this point and the lack of information about the second stage.’
ICB CEO Rob Hurd assured Dr Nagpaul and the health scrutiny committee that the total £6.6m is ‘ringfenced’ for general practice access and ‘will not be used for other services’, but its full usage this year is dependent on the outcome of the business case.
Director of primary care at the ICB Javina Sehgal said: ‘I just want to reassure the LMC and colleagues around the table that the money is set aside for access, it is not the intention of the ICB to use the money for anything else.’
On the details of how PCNs will access this money, she said: ‘Depending on whatever proposals come forward, we’ve told all our PCNs that they can get up to £2 per head of registered population to deliver and our intention was always going to be to spend £2.50 per head of population which works out to the £6.6m.’
A group of local patient representatives, which was vocal about the initial same-day hub plans earlier this year, has written to health secretary Wes Streeting raising ‘major concerns’ about the ICB’s plans.
In a letter seen by Pulse, they said ‘it is not clear whether same day access is a core component’ of the ICB’s new proposals on GP access.
On the patient surveys, which began last week, it said: ‘The ICB, through NHSE, already has the requisite data submitted by GPs on access/appointments which should show which practices are “doing very well” and which practices are “performing less well”.
‘We fail to understand why the ICB does not organise support for less well performing practices while they potentially risk destabilising good practices.’
More widely on the plans, the patient groups said: ‘Because of lack of clarity from the NW London ICB about what they are trying to achieve, we fear at the end of this process we will have reduced contact with our GP practices and even less with a named GP, but find ourselves being referred to unwanted “hubs”.’
In February, NHS England’s primary care director said she wants to ‘step back’ and let local systems get on with proposals to overhaul same-day GP access.
But NWL’s CEO Mr Hurd later argued that same-day access at scale is a ‘national imperative’ and therefore the ICB would not consult publicly on its plans.
How about an alternative : ‘Next Day Hubs’ !
When will my £ 5 million arrive?
A realistic response would be:
1. Take the remaining £2 / patient for practices to use as they see fit;
2. Expected output: marginal gain/reduction in deterioration of activity and access.
What proportion of same day “demand” could be dealt with by an ounce of common sense and the contents of a basic medicine cabinet. Thus leaving time to see others. We might even get around to seeing people with a high chance of pathology, rather than the usual merry go round of repeat attending 20% who swallow up 80% of appointments.