NHS contract 2022/23: Concerns over resourcing the extended hours
In a letter to GP practices on 1 March, NHS England and NHS Improvement detailed the general practice contract arrangements for 2022/23, which focus on long-terms conditions, urgent care needs, and disease prevention.
The contract remains largely aligned with the 5-year deal negotiated with the British Medical Association (BMA) in 2019, before the pandemic, but it also introduces some new requirements. The BMA has expressed bitter disappointment that after much discussion, the contract being imposed does not address the pressures now facing general practice. Many GPs may be especially concerned about the impact on staff of the new requirement for evening and weekend services.
The updated NHS contract
The NHS general practice contract arrangements for 2022/23 came into effect on 1 April 2022. Key changes being introduced include:
- Full reinstatement of the Quality and Outcomes Framework (QOF) requirements. The Quality Improvement modules for 2022/23 are focused on optimising access to general practice and prescription drug dependency.
- The extension of online patient registration and online appointment bookings.
- Changes to requirements regarding deceased patient records and access requests.
- Amendments to certain vaccination programmes.
- Extension of the enhanced service on weight management.
- Reintroduction of the friends and family test (FFT), with new guidance.
Amendments to the Network Contract Directed Enhanced Service (DES) are also being implemented, notably including measures to extend patient access and expand primary care capacity:
- Delivery of the planned Primary Care Network (PCN) Enhanced Access service, providing extended hours of appointments during weekday evenings and Saturdays, from 1 October 2022, with preparatory work from April (this was previously deferred due to COVID-19).
- Extension of Additional Roles Reimbursement Scheme (ARRS) recruitment, with a doubling of the limit on Mental Health Practitioner reimbursement.
Disappointment and calls for a new contract
The BMA strongly criticised the latest contract arrangements, which it says were imposed without their agreement or endorsement.
In the wake of COVID-19, the union had repeatedly requested additional resources to support general practice through pandemic recovery, with more flexible recruitment, funding to cover increased employers national insurance contributions, and a new ‘fit-for-purpose’ GP contract. However, the negotiations with NHS England ended in stalemate.
Dr Farah Jameel, the BMA GP committee chair for England, said: “We are bitterly disappointed that NHS England has chosen to ignore the appeals from the profession and the needs of patients.”
She added, “The letter does nothing to capture the scale of changes needed nor safeguards patients, and further highlights the need for a new contract that delivers high quality safe care in the new world we live in.”
Concerns about plans for Extended Access
In particular, the announcement that practices will be required to open for extended hours in the evenings and on Saturdays has generated concern and anger among many GPs.
By August 2022, PCNs are expected to agree plans with commissioners for Extended Access services. The requirement is to deliver multidisciplinary services, including routine appointments, during enhanced access network standard hours (6:30pm to 8pm weekday evenings and 9am to 5pm on Saturdays). A proportion of the enhanced access may be provided outside of these hours, according to patient need locally, if agreed with the commissioner.
At a time of intense workload pressures in primary care, many GPs think there is a danger that the requirement to offer extended hours will overstretch the workforce, threatening patient safety and leading more staff to quit the NHS altogether.
With a majority of GPs in England reportedly believing that PCN membership has added to practice workloads, without necessarily improving services for patients, it is unsurprising that these plans have prompted some practices to consider opting out. Indeed, at the BMA annual representative meeting in June, calls for the withdrawal of GP practices from PCNs by 2023, and even for industrial action “if necessary”, received majority support. However, opting out would mean losing access to the PCN participation payment, ARRS staff, core network funding and the impact and investment fund so it must be carefully considered.
As the new contract arrangements come into force, GP practice teams need to examine how the changes will impact on their funding and workload. They are advised to seek advice early to establish how to make the best use of resources to meet the new challenges in a way that benefits the practice, staff and patients.
The following links offer valuable additional information:
- NHS England: GP Contract 2022/23 financial information, including a practice and PCN income ready reckoner.
- BMA: GP contract changes England 2022/23, guidance on changes to the GP contract.
- BMA: Safe working in general practice, a guide to enable practices to prioritise safe patient care and protect the wellbeing of the GP workforce within the contract.
Members can contact us at Medical Defense Society for medico-legal support and advice relating to the new contract arrangements.