BGS responds to Update to the GP contract agreement 2020/21-2023/24

On Thursday 6 February, NHS England and NHS Improvement and the British Medical Association (BMA) agreed and published the Update to the GP contract agreement 2020/21-2023/24 which incorporates the service specifications for the Network Contract Direct Enhanced Service. These specifications were consulted on over the Christmas period and BGS responded to that consultation with extensive feedback. You can read our full submission or our summary BGS blog post.

Last week, NHS England and NHS Improvement published a summary of the consultation responses received and this week has published the agreed updated contract. We are very pleased to note that significant concessions have been made as a result of, in NHS England’s words, the ‘high and unambiguous level of concern’ expressed through the consultation.

The first and possibly most significant concession has been the deferment of two of the five specifications that were consulted on. The Anticipatory Care and Personalised Care specifications will now be reworked and introduced in 2021/22. In place of the Personalised Care specification, Primary Care Networks (PCNs) must provide access to a social prescribing service in 2020/21. A central theme of our feedback about the draft specifications was that they demanded too much, too soon of PCNs, especially as many of them are still in their infancy. As such, we feel that concentrating on three specifications this year is more realistic. However, we do feel that Anticipatory Care is particularly relevant to older people living with frailty. We urge NHS England to ensure that this population is prioritised while this specification is being reworked so that the revised specification delivers for this group. Many BGS members have expertise which could help with redeveloping this specification and we reiterate our previously made offer to help NHS England to get this right for older people with frailty.

Much of the concern expressed in the consultation period focused around workforce and the capacity of the current workforce to deliver the specifications. We are therefore pleased to see this contract deliver the additional investment in the NHS workforce promised in the Conservative election manifesto. The contract states that for the average PCN, this will mean an additional £344,000 in 2020/21, funding around seven Full Time Equivalent (FTE) staff. By 2023/24 this will rise to £1.13million or 20 FTE staff.

There was also concern that the specifications would place responsibility on PCNs for ensuring the delivery of services that were not within their gift. The revised contract specifies that PCNs do not carry contractual responsibility for any failure of community providers to deliver and vice versa.

In response to the announcement Professor Tahir Masud, President of the British Geriatrics Society, commented:

We welcomed the opportunity to comment on the draft specifications earlier in the year. We are now delighted that the feedback received during that consultation has been taken into consideration in the new GP contract. We previously expressed concern that the draft specifications placed a significant amount of additional work at the feet of GPs and Primary Care Networks (PCNs), especially at a time when PCNs are still in development. The revised contract recognises the support needed to implement these important new specifications. It has real potential to improve healthcare for older people living with frailty. While we support scaling back the specifications to focus on three key areas rather than five, we urge NHS England not to lose sight of the importance of Anticipatory Care. We invite NHS England to work with us and others over the coming year to ensure that the forthcoming Anticipatory Care specification focuses on the needs of older people living with frailty and helps PCNs to provide the best possible care to this population group.”

Of the three specifications included in the final contract, BGS was specifically concerned about two – Structured Medication Review and Enhanced Health in Care Homes.

Structured Medication Review (SMR)

BGS felt that this specification in draft form was not specific enough and not patient-focused enough. We are pleased that the revised list of patient groups who would benefit from SMR has been streamlined and that the specification has been rewritten to acknowledge the capacity of clinical pharmacists to carry out SMRs.

Enhanced health in care homes (EHCH)

In our response to the consultation, BGS welcomed the focus on healthcare for people living in care homes but was extremely concerned about the additional work that the draft specification would have placed on GPs and PCNs. We are pleased that this specification has been revised significantly and places more realistic expectations on PCNs.

We felt that the draft specification failed to acknowledge the geographic distribution of care homes with some PCNs serving many more care homes than others depending on their population. This is addressed by the introduction of a Care Home Premium which will entitle PCNs to an additional £120 per care home bed per year once CCGs have agreed the allocation of care homes to PCNs.

One of our key concerns with this draft specification was the introduction of a weekly ‘ward round’ for care home residents which, at least fortnightly, must be carried out by a GP. We are pleased to see more flexibility introduced to this requirement while still ensuring that care home residents have access to medical care when they need it. The revised contract specifies that residents will be prioritised according to need and clarifies that it is not intended to be a weekly review for every care home resident. There is also more flexibility around who should deliver the ward round with a focus on multidisciplinary team (MDT) involvement. The ward round must still have appropriate and consistent input from a GP or a geriatrician but the frequency and form of that input should be determined on the basis of clinical judgment. We are also pleased to see the inclusion of digital solutions to support the ward round and facilitate medical input.

The draft specifications stated that data sharing protocols between care homes and other partners must be in place by the end of June 2020. We were concerned about this as, while we applaud the intent, the reality is that most systems are not ready for this level of data sharing. We are pleased to see that the ambition of data sharing has been retained but that the deadline for achieving this has been extended to the end of March 2021.

Concluding thoughts

BGS, along with other stakeholders, felt that the direction of travel in the draft service specifications was overwhelmingly positive and our feedback was focused on the pressures that the specifications would place on an already stretched workforce. We are pleased that NHS England has taken heed of the feedback they received and has kept the ambition while scaling back some of the requirements.

NHS England should also be congratulated on consulting on this in the first place (particularly given the time constraints imposed by the election and the GP contract negotiations) and for turning around the feedback received in such a short period of time. We look forward to continuing to work with our members and NHS England to ensure that this contract delivers real improvement in healthcare for older people.