Sweeping changes to the Network DES will see £37m worth of funding reallocated towards direct support payments for improving core GP access this winter.

Four investment and impact fund (IIF) indicators, worth £37m in total. will be deferred or scrapped, with that funding instead allocated to PCNs via a monthly support payment from October and until 31 March next year.

This comes within a raft of measures intended to support general practice through the winter, following the health secretary’s controversial plan for patient access.

In a letter sent to practices and PCN leads (26 September), NHS England announced the new support payment will be paid to PCNs monthly and will be based on the PCN’s adjusted population.

It said: ‘In line with the reinvestment commitment relating to IIF earnings, the PCN capacity and access support payment must be used to purchase additional workforce and increase clinical capacity to support additional appointments and access for patients.’

To achieve this, NHS England said it would immediately defer three IIF indicators to 2023/24, including the target for GP networks to offer patients appointments within two weeks. And a fourth indicator, focused on identifying and tackling health inequalities, will be retired entirely.

Integrated care boards (ICBs) have also been asked to identify where to allocate potential additional winter support funding to GP practices and PCNs in their area, if such funding were to materialise.

NHS England also suggested the responsibility for the anticipatory care service will be shifted to integrated care systems (ICSs) to ‘better reflect system-level work’, from April 2023.

PCNs are now expected to ‘contribute to ICS-led conversations’ on the implementation and delivery of the anticipatory care service which will be designed and planned by the ICSs.

Meanwhile, the mandatory shared decision-making e-learning module – which GPs had branded a ‘waste of time’ – will also be scrapped, just four days ahead of the deadline.

The update also confirmed it will increase the ARRS maximum reimbursement rates for 2022/23 to account for the Agenda for Change uplift.

It also said it would up the current cap on hiring advanced practitioners (APs) through the ARRS, from one per PCN to two (double for those with over 100,000 patients), and will remove the minimum 0.5 FTE restriction on clinical pharmacists after they have completed their 18-month training course.

NHS England also announced that it will reimburse training time for nursing associates to become registered nurses who work in practices, and will also consider support for senior nurses within PCNs for April 2023 onwards.

The support comes as the UK health security agency (UKHSA) warned today that the UK could face a ‘twindemic’ of Covid-19 and flu infections this winter, with both infections expected to circle widely, the UK Health Security Agency (UKHSA) has warned.

A version of this story was originally published on our sister publication Pulse.

The four indicators

NHS England confirmed it will be deferring three indicators to next year:

ACC-02: Number of online consultation submissions received by the PCN per registered patient
EHCH-06: Standardised number of emergency admissions on or after 1 October per care home resident aged >= 18
ACC-08: Percentage of patients whose time from booking to appointment was two weeks or less.
And ACC-05 will be retired:

ACC-05: By 31 March 2023, make use of GP Patient Survey results for practices in the PCN to (i) identify patient groups experiencing inequalities in their experience of access to general practice, and (ii) develop, publish and implement a plan to improve patient experience and access for these patient groups, taking into account demographic information including levels of deprivation.
Three of these indicators took effect from 1 April 2022, while EHCH-06 was due to start from 1 October 2022.

Amended IIF indicators

NHS England has also amended the thresholds for two indicators to better reflect how they are carried out:

The threshold for CVD-02, which relates to the percentage of patients on the QOF Hypertension Register, has been reduced from a 0.6/1.2 percentage point increase to 0.4/0.8.
The threshold for PC-01, which relates to the percentage of patients referred to a social prescribing service, has been lowered from 1.2%/1.6% to 0.8%/1.2%.
It also amended the wording for two indicators to make them ‘easier to achieve’:

CAN-01, which recognises PCNs for ensuring that lower gastrointestinal fast-track referrals for suspected cancer are accompanied by a FIT, will change the permissible time between FIT result and referral from seven to 21 days.
And CVD-04 – which recognises PCNs for referring patients with high cholesterol for assessment for familial hypercholesterolaemia – will have its list of success criteria expanded to include diagnoses of secondary hypercholesterolaemia, genetic diagnoses of familial hypercholesterolaemia, and assessments for familial hypercholesterolaemia, in addition to referral for assessment for familial hypercholesterolaemia.