The Primary Care Access Recovery Plan (PCARP) asks all practices to move to delivering modern general practice over the next two years 2023/24 – 2024/25. This means accessing national funding offers and undertaking change management/quality improvement work to:

• Make best use of Cloud-based telephony systems
• Simplify online requests and digital self-service using integrated digital tools
• Implement faster and more effective triage and care navigation processes

Moving towards the modern general practice model will improve access and patient experience with the aim to tackle the 8am rush, provide rapid assessment and response, and avoid asking patients to ring back another day to book an appointment.

As part of the National General Practice Access Recovery Plan (NGPARP), all practices are asked to make the transition to the modern general practice operating model by March 2025. 

• Details of the access recovery plan and the practice checklist
• NCL presentations regarding the modern general practice
• Resources that practices might find useful
• Details of the national GP improvement programme

Several funding sources are available to support the work.

• All practices have been eligible to claim a share of the national transition cover and transformation support funding to support transition work. If you have not yet claimed yours, the ICB will be in touch shortly with more details.
• PCNs continue to receive monthly Capacity and Access Support Payments as described in the GP contract letter for 2024/25 – this can be used flexibly to enable joint working to improve access.
• PCNs can claim a 2024/25 Capacity and Access Improvement Payment in-year once all practices evidence (using national criteria) they have successfully made the transition to modern general practice. The ICB will write to PCN Clinical Directors about claiming funding once we have completed assurance and payments for 2023/24 plans.

The National Access Recovery Plan (ARP) required ICBs to provide a “hands-on” change support offer for a sub-set of practices who would benefit, based on our understanding of what support practices would find helpful. In autumn 2023 we wrote to practices describing our approach: 

• Reviewing publicly-available data e.g. the national GP Patient Survey results and the General Practice Appointment Dashboard (GPAD). This data was shared with PCN teams to support their capacity and access improvement planning;
• Practice-completion of an online survey describing support requirements. Almost all practices took time to share their thoughts. This information was also used to understand when practices wanted to receive their transition and transformation funding;
• Testing emerging themes with NCL clinical leaders in the ICB and in primary care provider organisations.
• Identifying a number of practices for an initial round of Support Level Framework (SLF) conversations. The SLF is national diagnostic tool for identifying a practice’s own ambitions and any development and support needs. Practices who have had an SLF conversation tell have reported that they have found the experience valuable; we are looking to expand this offer for 2024/25. 

This work gave the ICB an initial understanding of the types of support that may be needed, and the number of practices likely to want support. High-level themes from SLF conversations have now informed the offer. Several funded change management offers will be available to practices; some targeted to specific support offers, and some universal to all practices. If you have questions, contact Adam Backhouse e: adam.backhouse@nhs.net.

The Support Level Framework (SLF) is a nationally created diagnostic tool that practices can use to self-assess themselves against a range of domains, and use the outputs of that self-assessment to identify their priorities for change and improvement. 

NCL ICB will be facilitating a Support Level Framework conversation with some practices where the organisation would like to learn more about their aspirations and future plans as they work on their own improvement priorities. NCL ICB will be contacting those practices individually with more information. However, practices may find it useful to use the tool themselves to help self-assess as a team and set priorities, and the NHS England facilitator’s guide gives some suggestions about how to structure and run this conversation. 

The SLF also acts as a gateway to practices accessing the intermediate and intensive offers in the national NHS England » National General Practice Improvement Programme:

• Support Level Framework (SLF) tool
• NHS England SLF practice guide

The ICB has commissioned a programme of local change management support offers to GP practices to make the required transition to the modern general practice operating model by March 2025.

Universal support

A universal support offer of webinars and resources will be available to all practices, led by NCL Training Hub. This will include customised training sessions, peer networking opportunities, and resources to assist NCL practices integrating digital tools, developing access plans, and refining practice processes. Practices are encouraged to use the universal support offer to meet their specific needs in relation to modern general practice models. 

As part of the universal offer, NCL Training Hub is looking for case studies highlighting NCL practices successfully implementing aspects of modern general practice models. If you would like to showcase your practice in a case study, please reach out to igpf.ncl-pcarp@nhs.net.

Hands-on change support

The ICB also ran a procurement to appoint a provider for a hands-on change management to work with practices across NCL to offer change support. Islington GP Federation (IGPF) will lead the hands-on change management programme working with practices across NCL to offer change support. IGPF will use themes identified by NCL ICB to deliver a practical support offer that will complement the NCL Training Hub universal offer. This change management offer will be delivered in two formats:

1. Peer support sessions
2. 1:1 practice support

Led by subject experts and guest speakers, the peer-support sessions will guide small groups of practices in implementing digital tools and refining practice processes in order to support the shift to modern general practice. This will help to build skill development, confidence, and understanding across practice teams as well as enabling sharing of best practice

IGPF’s 1:1 support will provide a more intensive and personalised level of support than the peer sessions. A subject matter expert will help practices identify their areas of improvement and work closely with practices to design and implement a change plan according to those needs. In order to enable delivery, IGPF are interested in identifying colleagues across NCL who could act as subject matter experts – particularly those who have digital and/or operational expertise. A call for experts will follow.
 
The five NCL HealthWatches will be supporting exploration of patient experience of access in more detail, and will provide advice on communicating changes to practice operating models necessitated by the move to modern general practice to patients.

For more information please contact Igpf.ncl-pcarp@nhs.net

Other support

Other change management offers already in place include: 

• LTC LCS: change facilitators and clinical leads supporting the long-term conditions LCS; to continue in 2024/25. 
• Pharmacy First: Local Pharmaceutical Committees to help NCL pharmacies embed Pharmacy First, making sure they are set up to deliver a high-quality service. The LPCs’ experienced pharmacists will also be checking in with all practices over the coming months to help practices get the most from the service.
• The Digital First team has created a resource pack as part of the NCL General Practice Access Support initiative. The pack offers localised guidance on a range of key digital tools and practice processes tailored to meet the specific needs and ambitions of NCL practices. We recommend practice use this pack alongside the local change management offers. General Practice Access - On-demand Training - North Central London GP Website (icb.nhs.uk)

The ICB also continues to progress other priorities in the ARP including: 

• Promoting the NHS app, and alternatives to General Practice, such as community self-referral and Pharmacy First. 
• Embedding the commitments in the ICS interface consensus document focused on the primary / secondary care interface.

Claiming your transition and transformation funding

The majority of practices have already begun work on the transition to modern general practice and claimed their transition and transformation funding.

If you have not yet claimed yours, the ICB will be in touch shortly with more details. We may invite you to have a Support Level Framework conversation with us at the same time.

We’ll be in touch with all practices towards the end of the (2024/25) financial year to understand potential support requirements in communicating the changes to your patients. Keep an eye out for the universal support offers as they are advertised, and please consider responding to the calls for case studies to share your experiences when this comes out.

Support Level Framework conversations

For practices who’ve already completed a Support Level Framework – thanks for the time you gave to have the conversation – we hope you found this exercise useful.

The ICB has recently written to another cohort of practices inviting them to schedule an SLF conversation and we look forward to these conversations in the coming weeks and months.

As part of the SLF, practices have all identified a number of improvement priorities; the ICB has committed to supporting these where possible. Unless practices have concerns, we will share the improvement priorities with Islington GP Federation (IGPF). If you have concerns, contact Adam Backhouse e: adam.backhouse@nhs.net by 17 May 2024 to discuss. Islington GP Federation will be in touch to discuss the support they can offer you.

Support from Islington GP Federation

Islington GP Federation will begin contacting practices across NCL to discuss their change management support programme and how you can participate in the offers that are right for you. 

They will contact all of the practices who have had (or will be having) a Support Level Framework conversation – these practices will all know who they are. They will also contact other groups of practices who have not had an SLF conversation but where the ICB review process described above suggests they might want or benefit from support. The ICB will write to these practices in the next week with a heads up that IGPF will be in touch.

If you don’t hear from us but are interested in learning more, please contact the ICB primary care team via your usual contacts.