On 6 March 2023, NHS England published an overview of changes to the GP Contract for 2023/24. 

With these changes came new requirements and obligations around patient access, as well as changes to funding performance-based funding for primary care providers in England. From the end of April, these changes came into effect. 

But with the number of full-time, fully qualified GPs in decline, and patient numbers rising, many practices may be struggling to meet their new obligations, while others may find it challenging to understand what exactly has changed, and what they need to do next to fulfil the requirements of the contract. 

What has changed in the 23/24 GP Contract?

Patient access sits at the heart of the new GP contract. Authorities are concerned that increasing demand and overstretched services are causing patients to lose confidence in healthcare services. 

But access isn’t the only aspect of the contract to have been reviewed.  Four key changes have been made:

• Patient access, 
• performance-based funding, 
• Additional Roles Reimbursement Scheme (ARRS) flexibility, and
• childhood immunisations and vaccines

Here, we consider the impact of the changes  on access and performance-based funding and assess how these changes will affect primary care teams.

1) Access: what must practices offer patients who ask to see a GP.

Action required - providing more equitable access to care

For many practices, the volume of patient enquiries has become overwhelming. As a result, reception and triage teams may have been asking patients to contact them at a later date, particularly where an enquiry was not urgent.

Following the introduction of new access requirements in the 23/24 GP contract, practices will no longer be allowed to delay the processing of a patient inquiry.

Instead all patients, on first contact, should be offered an assessment of need or signposted to an appropriate service regardless of how they access GP services (face-to-face, phone or online). 

Health records - delivering patient-centred care

To make it easier for patients to access their health information online, all patients will be offered access to their medical records by 31 October 2023. This will make it easier for them to access their health information helping improve self-management and reduce unnecessary calls to the practice. 

Patients should be front and centre of their own health. Providing access to health records plays a key role in empowering patients to take charge of their own health. Having an understanding of their health status can help empower individuals to share decision-making and self-manage their conditions. 

Cloud-based telephony - ease of communication

The cloud-based telephony (CBT) National Framework will be mandatory and only cloud-based solutions will be supported by the end of 2025. When current contracts expire, GP practices must procure their telephony solutions through the Better Purchasing Framework.

CBT provides greater functionality for both practices and patients, with features including call queueing and call back which can help improve the patient experience. 

2) How is primary care funding changing in the 23/24 GP Contract?

Changes to the Quality and Outcomes Framework (QOF) 

QOF, the voluntary annual reward and incentive programme, will be streamlined in 2023/24 by reducing the number of indicators from 74 to 55 (a  25% drop). 

Once the 2022/23 QOF outturn is finalised, £97 million in funding will be paid monthly to practices based on 2022/23 performance. Two new cholesterol indicators (approximately £36 million) and a new overarching mental health indicator will be added to QOF. One indicator (AF007) regarding atrial fibrillation will be replaced with a similar indicator from IIF.

With up to one in four GP appointments considered avoidable in recent years, it may not come as a surprise that this year’s QOF Quality Improvement (QI) modules include a focus on workforce well-being and optimising demand and capacity in General Practice. 

The emphasis is on utilising data to reduce potentially avoidable appointments, leveraging the wider workforce, including ARRS roles and other staff to alleviate pressure on General Practice, and achieving a better understanding and control of demand and capacity. 

Changes to Impact and Investment Fund (IIF)

The value of the Impact and Investment Fund, designed to incentivise practices to provide high quality care to the population has now reached £300 million. Within the new GP Contract, the  number of indicators has been reduced to just five core indicators that align with key national priorities: 

• VI-02 and VI-03: Two indicators focusing on the percentage of patients receiving a influenza vaccination 
• HI-03: the percentage of patients on the learning disability register receiving an annual health check and with a completed Health action plan. 
• Two indicators of high quality cancer care - CAN-0 and ACC-08: based on the percentage of lower gastrointestinal fast-track cancer referrals accompanied by a test result, and the percentage of appointments taking place within two weeks of booking. 

The value of these five core indicators will be £59 million – the remainder of the Impact and Investment Fund (IIF) will be worth £246 million and entirely focused on improving access and patient experience. 

 70% of the £246 million pot (£172.2 million) will be paid out monthly to PCNs as part of the Capacity and Access Support payment. With 70% of the budget now being paid unconditionally on a monthly basis, PCNs will now have greater flexibility in how they use their funds with the ability to finance more forward-thinking innovative projects.

 PCNs will need to agree on an access improvement plan with commissioners in Q1 of 2023/24. The remaining 30% of the £246 million fund (£73.8 million) will be paid at the end of March 2024 to PCNs that have demonstrated and evidenced improvements in patient access in line with their access improvement plan. 

How practices can meet their obligations under the 23/24 GP Contract 

With patient access a priority within the contract – both explicitly and as part of the eligibility criteria for the IIF, identifying opportunities to streamline processes, monitor and manage demand, and ensure efficient triage will be essential for practices.

Meeting both access requirements and indicators around the avoidance of unnecessary appoints will require practices ensure that resources are allocated efficiently and effectively, and that staff time isn’t wasted by directing patients onto inappropriate treatment pathways, such as the use of in-person GP appointments where a phone call with an ARRS role may have been adequate. 

Achieving this will require triage that captures the required information from patients at first point of contact, regardless of whether an enquiry is made by phone or online. Technology can play an essential role in supporting GP practices, hubs and PCNS to capture that information as well as supporting the clinical decision making process to refer patients accurately. 

How does Klinik’s AI assisted triage support practices to prioritise access?

Klinik’s digital triage software captures 100% of data through a combination of online and telephony modules. Whilst the speed of access is important, providers must also ensure that patients with the greatest needs are prioritised. Klinik’s total triage platform enables primary care organisations like the Priory Medical Group to assess the priority and urgency of cases and automatically directs patients to the right point of care.

To improve the chances of securing reimbursement from the updated Investment and Impact Fund, PCNs need to heavily focus on data. Having comprehensive and structured data will ensure practices achieve the assessment and signposting requirements. Over the next few months, PCNs will need to start measuring baseline metrics for submission as part of their Capacity and Access improvement plan. At Klinik, the AI system offers valuable insights into how GP practices are running on a day-to-day basis enabling organisations to better predict and manage demand. 

Please get in touch to find out how we can help your healthcare organisation improve patient flow and care and tap into funding pots. 

Check out our webinar of the 22nd June to find out more about how changes to the GP Contract may impact your practice and understand opportunities to improve your practice processes to cope with demand,