Officials are working on a package of measures to be announced within the next few weeks which will include details on the roll-out of new care models and the enhanced GP services developed by the prime minister’s Challenge Fund pilots.
The announcement is expected to include details of investment, but GP leaders have questioned where the resources will come from and warned against raiding a £1bn fund initially allocated for GP premises. ‘The bottom line is where the resources are,' said GPC deputy chairman Dr Richard Vautrey.
The new package, expected to be revealed between mid and late January, could also include details of measures to cut GP bureaucracy first announced by Mr Hunt last October, including scrapping GPs' responsibility for hospital re-referrals following missed appointments, and the creation of a unified, single stream GP payments system. Other measures will support innovation in primary care.
The government has said it is committed to improving GP services, including ensuring that every patient in England can access an appointment seven days a week by 2020.
This manifesto commitment was written into NHS England’s mandate from government for 2015, which required the commissioning body to provide weekend routine GP access for a fifth of the population by 2017.
The DH and NHS England will set out how they intend to take forward that commitment through a combination of investment, workforce measures, measures to control workload and measures to support innovation.
Seven-day GP contract
NHS England officials are also developing a new voluntary contract first announced by the prime minister in October, which will support multidisciplinary community provider new care models to provide seven-day GP services.
The package to be announced later this month is likely to involve a phased approach, rolling out new models and supporting innovation in different parts of the country.
Mr Hunt told MPs on Tuesday the government was ‘looking at how to maintain funding’ for those areas currently piloting enhanced GP services under the Challenge Fund.
‘Already 16m people are benefiting from enhanced general practice in the evenings and weekends and we wouldn't want the clock to be turned back on that.'
The initial 20 wave one pilots were launched in 2014 with £50m of funding. A second wave of 37 pilots was announced in 2015 with £100m. The government also pledged to spend an additional £400m to ensure every patient in England has evening and weekend access by 2020.
A further £25.5m - part of the 2015/16 tranche of the infrastructure/transformation fund that pledged £1bn in total over four years - was designated for Challenge Fund pilots' IT interoperability. Some of the pilots have also benefited from additional local funding.
In the government spending review in November a Treasury document said that the roll-out of evening and weekend access would be ‘supported’ by the remaining £750m primary care transformation fund, initially announced in 2014 as a GP infrastructure fund and as part of the wider additional £2bn recurrent funding for the NHS.
Dr Vautrey said: ‘We know from the Challenge Fund sites that [evening and weekend access] has cost tens of millions of pounds to deliver and even then has been questionable whether it has given value for money on Saturday afternoons and Sundays.
‘They need to find the equivalent amount for other areas, but not only as a one-off. It needs to be recurrent. If you are going to have a sustainable service you need that long-term funding.
Dr Vautrey warned against repeating mistakes of the past by raiding funds set aside for primary care premises.
‘We cannot make the same mistake again,' he said. ‘We had a promise in the Five Year Forward View that they would invest in premises. The original £1bn [infrastructure/transformation fund] was highlighted. They have to honour that commitment.
An NHS England-commissioned independent evaluation of the wave one pilots published in October found ‘very low demand for access to routine GP services on Sundays. It said the cost of extended hours services were expensive compared with in-hours services, typically closer to the cost of an out-of-hours or locum service. ‘The typical average cost per total extended hour is in the range of £200 - £280,' the report said.
The report said £45m had been spent to date across the 20 pilots, and suggested the scheme could bring an annual cost saving of £3.2m from reduced minor A&E attendances, but this figure 'would need to be offset against the investment in primary care'.