The comments on requirements under the PCN DES contract that take effect from October come just days after GP leaders rejected suggestions from officials that a GP would need to be physically present in 'network standard hours'.
The comments also came as the BMA revealed it had requested a further opt-out period for GP practices in July - the deadline for PCNs to agree enhanced access plans with commissioners - so that practices unable to reach agreement can quit the PCN DES.
The 2022/23 PCN DES defines network standard hours as 6.30pm to 8pm on weekdays and 9am to 5pm on Saturdays - with networks required to offer a minimum of '60 minutes of appointments per 1,000 PCN adjusted patients per week' in these hours.
Enhanced GP access
The contract says these appointments must be bookable, available to all patients across the PCN, provided by a multidisciplinary team, involve a mix of delivery methods including face-to-face and remote consultations and be 'for any general practice services and services pursuant to the Network Contract DES that are provided to patients'.
GP leaders have warned that changes to the GMS contract for 2022/23 imposed by NHS England will add to pressure on general practice - and suggestions that a GP would need to be physically present throughout enhanced access hours have raised further concern.
At an NHS webinar for general practice on 5 May, NHS England head of GP access improvement John Taylor said: 'What we really want PCNs to do is actually design a service that reflects patient needs and having the right services with the right mix of staff within that service, whether it's GPs, nurses or ARRS roles.
'That's something that we really want to try to encourage, a bit of a blend of what that will look like - and how much of that is provided face-to-face and how much of that is provided remotely will be down to local determination.
'PCNs will also need to ensure appropriate clinical cover and supervision are always in place for the multidisciplinary team, where they're working in face-to-face services. This may be delivered by the appropriate clinician - doesn't necessarily need to be a GP - and may be offered remotely where there's more than one site in operation. So what we're really looking at there is making sure that there is the appropriate cover for people carrying out their duties, and they've got the appropriate ways of contacting people to help them discharge all the responsibilities safely and fairly.'
Despite the comments from Mr Taylor, in response to a question during the NHS England webinar about whether GP cover was required on site in every location if a PCN was delivering enhanced access services from multiple locations, representatives of the PCN for Barking and Dagenham said they planned to have GP cover in each place.
However, GPonline reported last week on advice from an LMC that GPs did not need to be physically present at all times because this was not a requirement in core hours.
GP Survival chair Dr John Hughes told GPonline that confusion over the requirements of the contract came because people with 'no concept of the practicalities or actual contractual requirements' were 'talking off the top of their heads' about services that they wanted to see practices deliver.
'Unfortunately that has always been the way,' he said. He added that the drive to expand services in so-called extended and enhanced access hours was the result of NHS leaders failing to deliver adequate services outside core hours since the bulk of practices opted out of out-of-hours responsibility in 2004.
'They took 6% of GMS [funding] in 2004 and responsibility for out-of-hours has lain with commissioners and NHS England since then. It is their job to commission and sort that out. They are now trying to devolve that responsibility for Saturdays and evenings to the PCNs and GP practices and doubling up on provision - because out-of-hours services will still be running at those times.'
He added: 'The outcome will be that they drive more GPs to retire earlier.'
On calls for a further opt-out window, Dr Sharrock said: 'The opt-out window for the PCN DES has now closed, but the BMA remains open to discussions with NHS England and NHS Improvement about how to improve the flexibility of the programme.
'PCNs have until July to agree plans for extended access with their CCG, and we have requested from NHS England another opt-out window be opened, so that practices who cannot agree a delivery model with their local commissioner - which is safe for both patients and the limited number of primary care staff we have - can withdraw from the DES.
'Patients should be reassured that surgeries will withdraw from the PCN DES only if they think it is safe and in the best interests of their communities. Any practice which opts out will continue to look after patients, but without additional unachievable targets that could be taking them away from addressing the unique needs of that particular community.'