Context
Over several years before and following the most challenging phases of the COVID-19 pandemic, access and continuity in primary medical care in England and public satisfaction have steadily declined. While the proportion of appointments taken up the same day remained constant [1], the large-scale GP patient survey showed people found it harder to make contact, get an appointment, and see the doctor of their choice [2]. An important point of context is the steadily declining numbers of general practitioners relative to the size of the population in England.
Impetus for the reform
The delivery plan was motivated by a political and policy drive to improve access to general practice. The British Social Attitudes Survey showed public satisfaction, previously high, declining to an all time low in 2022 [3].
Main purpose of the reform
The delivery plan, published in May 2023, emphasized improving access to appointments as its overarching goal. It sought to do this by removing and rerouting some activity to free up clinician time and capacity; by improving the technology used for contact and triage; and by increasing total workforce capacity. Its targets and actions focused on achieving these intermediate goals, rather than setting an explicit commitment or ambition for improving access.
Content and characteristics
Measures to reduce demands on general practice staff included new provisions for community pharmacists to prescribe medicines including antivirals and antibiotics for seven self-limiting conditions, including sore throat and uncomplicated urinary tract infection. This is described as the “Pharmacy First” initiative and is to be permitted through directives expanding the scope of pharmacist practice for specific patient groups – an established mechanism. There was also a commitment to expand existing initiatives for pharmacists to manage blood pressure consultations and ongoing oral contraception.
A funding increase of £645 million over two years has been allocated for these pharmacy initiatives, and other group directions will enable pharmacy technicians to dispense medicines, aiming to free the time of fully qualified pharmacists.
There are also measures and processes to reduce administrative work relating to patients referred to secondary care. This includes requiring secondary care providers to issue their own referrals for related or immediate needs, and their own recalls to patients after treatment, rather than sending patients back to general practice.
A programme of supporting practices to adopt cloud-based telephony services described as “Modern General Practice Access” is included within the plan, with £240 million in existing funds reallocated as funding. Practices signing up within two months were to receive support with procurement, contracts, training and transition funding. Fully funded online consultation tools will also be provided.
On workforce capacity, an existing programme reimbursing 50% of payroll and other costs for employing non-medical staff including pharmacists, mental health workers and paramedics was extended with additional funding. The plan set out the introduction of more streamlined review and approval processes tailored to individuals seeking to return to work having left general medical practice. The plan also emphasizes the earlier extension of tax allowances for pensions among higher earners, seen as relevant to many doctors, and the gestures to the Long Term Workforce Plan published the following month, which expanded GP training.
Implementation steps taken
NHS England has implemented the process of practices bidding for and receiving support for adopting digital telephony [4]. A consultation has been opened on group directions to enable pharmacy technicians to dispense medicines.
Outcomes to date
Assessing the impact on patient experience of access relies primarily on England’s large annual patient surveys, not yet available for this period. Activity data is likely to be analyzed in future for further changes, but any changes would be expected to be at an early stage. No specific evaluation has been commissioned of the delivery plan as a whole. The Department of Health and Social Care has commissioned an evaluation of the new “Pharmacy First” provisions [5].