Enhanced access requirements imposed by NHS England under the 2022/23 GP contract call for practices to work together at PCN level to deliver at least 60 minutes of appointments per 1,000 adjusted patients per week in 'network standard hours' - 6.30pm to 8pm on weekdays and 9am to 5pm on Saturdays.
PCNs have until 31 July to submit enhanced access plans to local commissioners setting out how they will deliver a mix of face-to-face and remote consultations - using a multidisciplinary team that includes GPs - from October 2022.
However, with just days to go until the deadline for submitting plans, GPs in some areas say the demands of enhanced access will prove too much for a paper-thin workforce. In other areas, GP leaders have warned NHS commissioners they may need to be flexible - with PCNs set to submit plans setting out what they can deliver, but that may fall short of the full PCN DES requirements.
Leicester, Leicestershire and Rutland LMC spokesperson Dr Grant Ingrams said that PCNs were trying to work out how to provide the services but faced insuperable obstacles.
‘We can’t invent more GPs,’ Dr Ingrams said. ‘It’s absolutely barmy. They are forging ahead with this when our workload is so high it can be seen from space.’
Tower Hamlets LMC chair Dr Jackie Applebee - also chair of Doctors in Unite - said it was not possible for GPs to offer extended hours. ‘We don’t have the capacity to see patients now, never mind with enhanced hours,’ she said.
Warnings over the feasibility of delivering enhanced access across PCNs come after NHS England turned down a BMA request for an additional opt-out window to allow practices to quit the PCN DES between now and October if they felt unable to meet the requirements.
Nottinghamshire LMC chief executive Michael Wright suggested PCNs could hand in enhanced access plans based on 'what they feel they can do'. He said that if the plans were not fully in line with the PCN DES specification, it would produce a conversation between PCN and commissioner about what was feasible - and an opportunity for LMCs to support practices in pushing back.
'I'd always encourage them to do what they think is manageable,' he said. 'Follow what you can do, but let's talk about it when the commissioner responds rather than not put it in because you're scared they're not going to accept it. The worst that happens is we have a conversation about it.'
Concerns that practices may be unable to deliver the enhanced access requirements in full come after a year in which general practice delivered an unprecedented 367m appointments with a workforce that remains in decline.
Dr Ingrams warned that meeting the enhanced access demands could undermine core-hours services. He said: ‘We haven’t got the workforce for extended hours. We will have to take services out of weekdays. This will have an effect on healthcare, increasing health inequalities.’