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.

• PCNs continue to receive monthly Capacity and Access Support Payments as described in the Network Contract DES; contract specification 2025/26 (page 62-64) - this can be used flexibly to enable joint working to improve access.
• PCNs can claim a 2024/25 Capacity and Access Improvement Payment as described in this guidance (page 45-48) in-year once all practices evidence (using national criteria) that they have successfully made the transition to modern general practice. The ICB will write to PCN Clinical Directors about claiming funding once assurance and payments have been completed 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 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 the primary care team on nclicb.nclprimarycare@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. This is led by Islington GP Federation, with support from change managers and subject experts across the five NCL boroughs. The 12-month programme was granted a six-month extension and will run until the end of September 2025.

Change management support available to practices

From now until September, the extended PCARP change management programme is ready to work with NCL GP practices to support their local change projects. These projects are chosen by practices, with support from the change managers, and aim to improve access by easing workforce pressures, using digital tools, and supporting patient access based on their healthcare needs. 

Practices can access support with: 

• Building change management and QI skills for adopting new ways of working 
• Digital Transformation Leads (or another role equivalent) development sessions 
• Designing reliable and efficient triage systems 
• Using practice data to balance demand and manage capacity 
• Smarter digital and telephone systems that improve access and efficiency 
• Directory of support for interdependent projects, including digital inclusion, NHS app and Pharmacy First.

NCL practices can access the PCARP SharePoint site which provides links to peer support sessions, webinars, key guidance, and NCL-specific materials.

If you would like access the SharePoint site, contact igpf.ncl-pcarp@nhs.net

You can feedback support needs of your practice and request an in-person practice visit by the PCARP change programme team by completing this short survey. This offer is open to all practices across NCL. 

If you have any additional queries, email: igpf.ncl-pcarp@nhs.net

Other support

Other change management offers already in place include: 

• NCL Training Hub has educational materials to support practices with change management support relating to PCARP and modern general practice. 
• 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. 

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.

Support Level Framework conversations

For practices who have 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 any questions, contact the primary care team: nclicb.nclprimarycare@nhs.net. Islington GP Federation will be in touch to discuss the support they can offer you.

Support from Islington GP Federation

Islington GP Federation will continue to contact practices across NCL to discuss their change management support programme and how they can participate in the offers that are right for them. 

In the meantime, you can feedback support needs of your practice and request an in-person practice visit by the PCARP change programme team by completing this short survey.