GMS and PMS Regulations and APMS Directions have been amended to formalise changes to the GP contract during the pandemic. The changes below apply from 30 March until 30 June 2020.
The following work can be suspended:
- New patient reviews, including alcohol dependency. Practices can also cancel appointments that have been offered but not yet taken up based on their clinical judgement. High-risk patients should receive a remote appointment.
- Over-75 health checks.
- Annual patient reviews, including under QOF, can be deferred if necessary, unless they can be conducted remotely or in exceptional circumstances by home visit.
- Routine medication reviews - key medication reviews where patients are routinely monitored should continue.
- Clinical reviews of frailty.
- Friend and Family Test - see below for more details on this.
- Engagement with and review of feedback from PPGs.
- Dispensing list cleansing.
Friends and Family Test
The Friends and Family Test suspension means practices are no longer required to keep a count of responses collected during the suspension period. Practices will be advised when to restart submitting data 'later this year', the guidance says.
The requirement to change the standard Friends and Family Test question has also been postponed. Practices that have made the change or planned to make the change can continue with the new version.
Additions to the contract
Bank holiday opening
Core hours have been changed to include Good Friday, Easter Monday and the May bank holidays.
Practices are now required to make 1 appointment per 500 registered patients available per day for direct booking by NHS 111. This is an increase from the 1 per 3,000 patients that practices originally had to make available under the GP contract.
Regulations have also changed to give the health secretary the power to increase this number, which 'in some cases, could extend to the whole appointment book', the guidance says.
There is more detail on this and how NHS 111 will work with practices during the pandemic here.
The newborn and infant physical examination (NIPE) can be delayed until 8 weeks of age to conincide with the first childhood immunisations so that they can be done in one visit.
Access to online patient records
Practices are not required to grant access to patients' full historic record during the coronavirus outbreak. NHS England has confirmed that there were already provisions in contract regulations to allow for a delay if a practice felt it would have negatively impacted on providing services and this would apply during the pandemic.
NHS England's latest guidance says: 'we recognise practices are unlikely to have the capacity to grant access to patients' full historic records during the outbreak.'
NHS England and NHS Improvement are introducing an NHS-wide 'pause' on the NHS complaints process for the next three months. However, NHS England has said that practices can continue to operate their usual complaints process if they wish.
If practices decide to pause, patients and the public should still able to raise concerns or make a complaint. They should be advised that an investigation and response in the near future may not be possible.
Practices should continue to log complaints, triage them for patient safety or safeguarding issues and take action immediately if necessary. All complaints will then remain open, unless an informal resolution is achieved or the complainant withdraws their complaint.
The guidance says that 'consideration should be given to complainants ... who have already waited excessively long for their response (specifically those who have waited six months or more). These should be reviewed to ascertain if and how these can be resolved to the complainant’s satisfaction'.
Primary Care Support England (PCSE) has paused all routine list reconciliation and data quality checks, apart from activities required to ensure new patient registrations are processed in a timely manner.
Calculations for QOF for 2019/20 will be made as usual. However, NHS England will pay a one-off adjustment to practices who earned less in 2019/20 than 2018/19 as a result of COVID-19.
Network contract DES
Practices have been urged to 'reconfirm their participation' in the network contract DES as soon as possible to avoid any interruption in PCN funding during the 'critical moment' of the coronavirus pandemic.
A letter to practices sent on 31 March said that this would enable PCNs to 'focus on the response to COVID-19 and move forward as swiftly as possible with using the DES to build their capacity and support their resilience'.
The deadline for practices to sign up to the network contract DES for this year is 31 May 2020.
The letter also confirmed that PCNs will not be required to start delivering any of the service specifications associated with the network DES until 1 October, as a result of the COVID-19 outbreak.
Requirements for the structured medication review and early cancer diagnosis service specifications have been deferred until 1 October, although PCNs have been asked to begin work as early as possible on the early cancer diagnosis specification.
The enhanced health in care homes requirements remain the same as orginally planned. While there are some elements of this that PCNs will need to complete before the end of September, funding for this service and the associated work was not due to start until 1 October anyway.
NHS England has also postponed the introduction of the Investment and Impact Fund 'for at least six months'. The fund was a new funding stream that was intended to work like the QOF and reward PCNs for providing high quality care and tackling health inequalities.