Are we trying to read between the lines when the writings on the wall?
Over the next few days there will be a lot of good summaries produced on the changes in the next GMS contract – probably best to let AI produce the summary for us, my focus in this note is to highlight what I believe to be the most significant change – this isn’t specifically referenced in the letter but we can read between the lines.
The change in the relationship between General Practices and Primary Care Commissioners
I believe that practices must prepare for a significant change in the way that they are ‘managed’ within the NHS. There are a number of reasons why we know this is coming:
1) The text included in the Medium-Term Planning Framework (Nov 25)
The Planning Framework made it clear that ICBs should:
“Ensure practices are delivering the 2025 / 26 GP contract (including recent 1 October changes) and the 2026 / 27 GP contract from April, including improving and providing good access whether by phone, online or walk-in throughout core hours”.
“Put in place action plans to continue to improve contract oversight, commissioning and transformation for primary care, and tackle unwarranted variation,”
These paragraphs indicated an intention for a significant strengthening of performance management and scrutiny – The changes referred to in the Planning Framework are included in the 26/27 contract changes.
2) The changes to the ICB workforce and the reduction in the number of ICBs
The indications are that the biggest impact of the staff reductions will be on local ‘place’ functions. It seems likely the central ICB Teams will be strengthened and taking on the commissioning and contract management currently done by place-based teams. We know for example that in some areas there are plans to have a standardised LES offer which has already been done in Staffordshire and across Lancashire and Cumbria.
3) The new 26/27 GMS requirements
The new Contract will require the collection of information to support the identification of unwarranted variation i.e. practices being subject to intervention. These include:
• Data for the following metrics
- call waiting time between 8am and 10am
- call waiting time during core hours
- percentage of clinically urgent seen on the same day
- percentage of ‘non-clinically urgent’ seen within 1 week
- percentage of ‘non-clinically urgent’ seen within 2 weeks
• Requiring practices to provide timely data and information related to online and video consultation services.
• Requiring that practices and PCNs to participate in the General Practice Staff Survey, by sharing staff contact details with their ICB so personalised survey links can be issued.
• Requiring practices to display opening times for all modes of access (walk‑in, telephone and online consultation) on their website, in their practice leaflet and within practice premises. As a minimum this must be core hours for all modes of access.
These metrics to be in addition to existing data sources such as GPAD Dashboard, and perhaps most importantly the GP Patient Survey.
So what does this mean?
My reading of the planning guidance, the new requirements in the contract, and the changes to ICB Primary Care Teams leads me to conclude:
• Contract management will be more remote comparing practices over bigger footprints – using metrics to determine practices that have ‘unwarranted variations’.
• Contract management will be more robust and rigid.
• Each ICB will be required to identify practices to be subject to external ‘support’ and practices are to be contractually required to engage with the ‘support’.
“We will amend the core practice contract to require practices to engage with support from their ICB where unwarranted variation has been identified in contractor performance. This includes where practices are not meeting their requirement to see all clinically urgent patients on the same day or are at risk of contractual breach”.
In short, we are moving towards more robust monitoring undertaken at a distance, focussed on a limited number of metrics.
So what can (should) practices do?
Here is our advice:
1) Follow the wildebeest principle – make sure you are in the pack – the lion will pick off any stragglers so always best to be in with the pack in terms of data and metrics.
2) Check your data quality – ensure your data is correct and importantly make sure you record, code and count everything you do.
3) Understand your data – do you know what the GPAD data says about you in comparison to others? Do you know what the Telephone data says and how this compares? Do you need support to help you access the data?
4) Triangulate your data – don’t just look at data sources in isolation – for example, if you are in the lowest quartile in the GP Patient Survey for access you need to look at the GPAD data on appointments offered.
5) Recognise the absolute link between the ICB data and the CQC – the intelligence sources are going to be the same, so being ‘in the pack’ for both should be the minimum aim. Remember the new (more remote) ICB contracting team will be the ones responding to any CQC initial enquiries and will simply supply the data rather than offering any local view.
6) Start thinking about the Staff Opinion Survey – remember that there is absolute evidence that happy staff deliver a better service (and are more productive) therefore a focus on this is to your benefit as well as ‘feeding the beast’. We will produce a separate note on the techniques to employ however an initial recommendation is for you to run your own survey now!
7) Spot Red Flags and Own Goals - try to see if there are any obvious Red Flags – for example we recently looked at a number of practice websites and spotted several practices whose published reception opening times did not meet the contractual requirements.
8) Make a realistic assessment of GMS and PCN DES compliance - it may be that there are areas where you don’t fully comply with the absolute ‘letter’ of the contracts. For example, the Enhanced Access requirements. Our advice is that if you identify areas where you don’t fully comply you don’t need to change arrangements now (if you haven’t been pulled up on these previously) but you need to be aware and have contingency plans (or clear justifications).
9) Ensure you are keeping abreast of new regulatory and contractual requirements. We know it is almost impossible however, as an example, our CSO service has been very busy because practices have become aware of the new CQC requirement for proof of CSO sign off for AVT tools used in practices.
10) Engage the Partners and Senior Team – the motivation for this may be driven by the need to be contractually compliant but lots of these actions are simply good management. Therefore, the Partners and the Senior Team need to be fully engaged and want to do these things for the right reasons. Many practices have developed a robust ‘balanced scorecard’ for Partners meetings – looking at both the quantitative data and qualitative assessments.
Mike Pyrah, Co-Founder, Howbeck Healthcare
