Just 24 hours after GP leaders condemned a 'deafening silence' from chancellor Rishi Sunak on financial support for GPs in his 'mini budget', a letter from NHS England promised an announcement 'shortly' on the COVID-19 support fund for general practice.
The letter spells out a broad update on how the GP contract will operate in the second phase of the NHS pandemic response. It says practices that suspended work such as new patient reviews, over-75 health checks, clinical reviews of frailty and medicines reviews in line with flexibilities brought in to help practices respond to the pandemic should now re-start those services.
Some changes brought in early in the pandemic will continue, however - friends and family tests will remain suspended and a relaxation of rules around individual patient consent for patients to be transferred to electronic repeat dispensing will remain.
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Practices will also continue to be required to make an increased proportion of appointment slots available for direct booking by NHS 111, with a minimum of 1 slot per 500 patients to be made available. Some of these changes could be reversed locally by CCGs in the event of a local outbreak, the letter makes clear.
The letter says 'digital consultation should be offered as standard unless there are good clinical reasons otherwise' - making clear that the total triage model adopted across primary care from the start of the pandemic should remain in place.
Normal operation of the QOF will not resume until the 2021/22 financial year, the letter confirms, with QOF requirements for the current year set to remain significantly reduced. However, the letter says practices should 'gear up for a major expansion of the winter flu programme', which looks set to be managed through the QOF.
Other targets will be 'recast' for the current financial year, and talks are underway with the BMA to finalise plans for practices to be offered QOF income protection 'subject to the delivery of revised and simplified requirements focused upon care delivery to those patients at greatest risk of harm from COVID-19, uncontrolled long-term condition parameters and those with a history of missing reviews'.
PCNs have been told to 'take immediate steps to plan to expand capacity' - with NHS England warning that hundreds of millions of pounds in funding for additional roles recruitment through the networks will be lost to primary care if it is not spent in the current financial year.
The NHS England letter re-commits to work to boost the GP workforce, and spells out changes intended to reduce bureaucracy - following warnings from both the BMA and RCGP that the health service must learn from the high-trust, low bureaucracy approach taken during the pandemic to ease pressure on primary care in future.
The letter highlights an overhaul of GP appraisal as a 'priority area for action'. It says the current process is being redesigned in light of the COVID-19 pandemic and that the NHS will take 'a flexible approach to its re-introduction'. Changes to appraisal will be designed to 'anchor the new approach around professional development and support, focusing on well-being as well as minimise the supporting information requirements'.
GPs and other practice staff unable to see patients face-to-face because they need to shield during the pandemic 'should continue to receive full pay', the NHS England letter makes clear. 'They should also be encouraged and supported to work remotely while they are doing so, in light of the home working solutions we are facilitating.
NHS England has also confirmed that practices forced to close premises and consolidate staff onto another site during the pandemic would have their income protected, and set out details of reimbursement for lost DES and enhanced services income.
BMA GP committee chair Dr Richard Vautrey said: 'The details set out in this letter provide some clarity on what is expected of GP practices in the coming months as we move beyond the first wave of this pandemic.
'The flexibilities around QOF and income protection are positive and will help practices adapt to a more normal footing and we will be working with NHS England on the outstanding details.
'However, GPs continue to work with the uncertainty of possible outbreaks in the future and the impact this could have on practices and so NHS England and CCGs must respond to this whenever necessary.
'We are also eagerly awaiting the details of the COVID fund, as was promised almost four months ago, with practices that acted swiftly in good faith yet to be reimbursed for additional costs they incurred.'