Earlier this month NHS England published an overview of changes to the GP Contract for 2023/24, the final year of “Investment and Evolution: A Five Year Framework for Reform of the GP Contract to implement the Long Term Plan”.

The main points of change are summarised below:

Access

• Practices cannot request that patients contact them at a later date. Instead, patients should be offered an assessment of need, or sign-posted to an appropriate service at first contact.

• Future online record access will be offered to all patients by 31st October 2023.

• The cloud-based telephone (CBT) national framework will be mandatory and only cloud-based solutions will be supported by the end of 2025.

• Practices must procure their telephony solutions through the Better Purchasing Framework when their current contracts expire.

• The Enhanced Access requirements will be reviewed in 2024 following conversations with PCNs and urgent and emergency care.

Performance-based funding (IIF and QOF)

IIF

• 55 indicators (down from 36) worth a total of £59 million

• These indicators will target flu vaccinations, learning disability health checks, early cancer diagnosis, and 2 week access targets.

• The remainder of the IIF (worth £246 million) will target access and patient experience.

• 70% of total funding (£172.2 million) will be paid out monthly as part of the Capacity and Access Support payment to PCNs.

• PCNs will need to agree an access improvement plan with commissioners in Q1 of 2023/24. The remaining 30% of the total funding (£73.8 million) paid at the end of March 2024 following an assessment of the improvements promised in the plan and what was delivered to patients.

• Guidance on this assessment will be provided to ICBs by NHSE.

QOF

• £97 million in funding to be released to practices by reducing the number of indicators from 74 to 55. All register indicators will be income protected and payments will be made monthly.

• New indicators include:
  • 2 cholesterol indicators worth 30 points (approximately £36 million)
  • New overarching mental health indicator.
  • Replacement of indicator AF007, concerning atrial fibrillation.

• 2023/24 QI modules emphasise the use of data, workforce and partnering with local services to improve workforce wellbeing and balancing demand and capacity.

• Consultation on the future form and suitability of QOF will be undertaken in 2024/25.

ARRS Flexibility

• New roles:
  • Advanced Clinical Practitioner Nurses will be included in the ARRS as advanced practitioners.
  • Apprentice Physician Associate.

• The cap on advanced practitioners will be raised to 3 per PCN under 99,999 patient population and raised to 6 for larger PCNs.

• The cap on Mental Health Practitioners will be removed.

• The contract will also clarify that they can support some first contact activity.

• Time spent away from practice, in education and training, will be reimbursable for First Contact Practitioners.

• Advanced Practice Pharmacists will be confirmed as able to supervise Clinical Pharmacists.

• Staff employed through the ARRS scheme will be considered part of the core general practice cost base beyond 2023/24. General practice is encouraged to offer permanent contracts where appropriate and continue to recruit into ARRS roles.

Childhood Immunisations and vaccines

• The ‘clawback’ vaccination and immunisations repayment mechanism for practice performance below 80% coverage for routine childhood programmes will be removed.

• QOF indicator thresholds to be changed to 81-89% for the lower threshold and 96% for the upper. This will see fewer practices receiving no payments across the 3 indicators.

• A new Personalised Care Adjustment will also be introduced for patients registering late.

• The routine vaccination schedule for Human Papillomavirus and Shingles will be changed.