Good ideas to improve NHS services have to be shared with GP federations and PCNs for everyone to benefit from them

The update to the new GP contract looked like it might free up a bit of workload for NHS clients.

Reducing 25 per cent out of the Quality and Outcomes Framework (QOF) and reducing 36 Investment and Impact Fund indicators down to five looked like it would mean less work for the Primary Care Networks (PCNs).

But PCNs across the country have been working hard to improve access for patients and therefore qualify for extra funding. The question is, how can you get your share?

Better access and capacity are the keys to Investment and Impact Fund success

While the PCN DES (Direct Enhanced Service) remains completely unchanged, the Investment and Impact Fund (IIF) is now being treated in a different way. Instead of having to chase indicators, they have the clear task of having to work out how to improve access and capacity.

The reduction of IIF indicators to five is designed to support a small number of key national priorities:

  • Two indicators in flu vaccination
  • Learning disability health checks
  • Early cancer diagnosis
  • And the percentage of appointments where time from booking to appointment was two weeks or less.

The value of those indicators is £59million pounds – that’s the sum that can be earned and paid out.

The remainder of the IIF is now worth £246million and that will be entirely focused on improving the patient experience of contact in their practice and being assessed and/or seen within an appropriate timeframe. That could be on the same day or within two weeks, where appropriate.

So, 70% of that total funding – that’s £172.2 million – will be provided as a monthly payment to PCNs during 2023/24. So, it’s similar to what practices would understand to be the monthly QOF aspirational payment.

Millions up for grabs for PCNs

The remaining 30% of that funding pot - £73.8 million – will be assessed against gateway criteria at the end of March 2024 by the Integrated Care Boards and paid out to the PCNs for demonstrable and evidenced improvements in access for patients.

That works out at £2.765 multiplied by the adjusted population of the PCN, divided by 12 to get the 12 monthly payments. So, there’s a lot of money being paid out to improve access, capacity and patient experience.

The PCN agrees on how to spend the cash to deliver improved access and experience and there are lots of different roads they can go down in terms of signposting people and increasing capacity.

I’ve seen some really innovative pieces of work, particularly regarding patient experience of contact where networks are analysing the Friends and Family Test and trying to take action to improve the services and the response.

I’m aware of local surveys covering the patient experience around enhanced access and some of the subsequent appointments and plans that come from that.

There’s also lots of work being done with reception teams being trained to help assess the patient’s needs and clear them away from the practices and investigations into cloud and digital solutions to manage telephony demand.

And there are projects involving online consultation, instead of everything having to be face to face.

Innovative planned care projects are bringing down appointments

There’s also work going on to lever the maximum amount out of the Additional Roles Reimbursement Scheme, helping patients access other team members and not just GPs. We’ve seen increased referrals to the Community Pharmacist Consultation Service, with the lower acuity work transferred away from general practice.

The NHS app is being used in different and better ways and these digital solutions are a key ingredient when it comes to improving access and capacity.

But I’m also working with networks that are looking at improving some of their planned care work. Rather than just increasing access and capacity, they’re thinking about projects that would potentially improve the patient outcome, reducing the workload in terms of appointments in general practice and referrals and admissions to hospitals as well.

There are lots of brilliant innovations out there in planned care at practice level, all targeted at trying to improve access and capacity for the patient and to relieve some of the workload pressure.

I’ve seen mental health projects where they’ve spent some of the access and capacity money to buy access to digital solutions. I’ve seen work in cardiorenal metabolic syndrome – diabetes, heart failure and chronic kidney disease – allergy, women’s health, and wound care.

This is a one-year deal, so we don’t know what’s going to happen next year with this. But I do believe there will be some pockets of absolute brilliance going on out there.

And it's really important that we get to hear about what’s worked well for the different PCNs because it will be different from place to place. We must take the learning and help people implement the very best outcomes that we can across the NHS.

Scott McKenzie helps GPs, PCNs and GP federations build sustainable and resilient practices and organisations that thrive.

About the author
Scott McKenzie

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