The letter says current levels of “overwhelming pressures and demand” mean practices are being pushed “beyond capacity” and calls for QOF and IIF to be suspended, and income to be protected within ICB areas to enable practices to “focus on delivering care for those patients who are contacting practices desperate for our care”.
NHSE&I subsequently communicated to NHS regional directors late December 2022 that ICBs cannot suspend/protect QOF without either a level 4 national emergency or 12 weeks local consultation (see below). However, we are aware that NHSE&I have previously agreed to suspend/income protect QOF and IIF at various times in the past, including before the pandemic and without level 4 emergency status or patient consultation.
As this is a nationally managed issue, BMA have advised that they will continue to liaise with NHSE&I on this issue, and that they have requested that extra support be made available direct to practices.
NHSE&I letter to regional directors
“Dear ICB colleagues
Briefing note on primary care and winter pressures
I have received a number of queries from ICBs about how systems can support general practice over the winter period including questions on whether or not commissioners can make local changes to parts of the national contract such as QOF and IIF. The purpose of this note is to clarify the current position
In a letter to systems (Supporting general practice, primary care networks and their teams through winter and beyond, 26th September 2022) Amanda Doyle, National Director, Primary Care and Community Services confirmed actions in place to support Practices/PCNs this winter to boost capacity, including immediate changes to the general practice contract:
- Further flexibility to the Additional Roles Reimbursement Scheme (ARRS) and addition of two new roles
- Suspension of a range of Investment and Impact Fund (IIF) indicators (c£37m), with associated payment to be paid out monthly as a PCN capacity and access support payment
- Amendment of contractual requirements on PCNs in relation to personalised care and anticipatory care
- In addition to the changes above £40m is being provided to systems to support the requirement for each system to roll out ARI hubs locally. This funding will support systems to commission additional capacity for patients with respiratory type illness who typically need a same day assessment.
The GP contract is nationally negotiated and I can clarify that commissioners are not able to make local changes to the national QOF and IIF schemes, including suspension and income protection; to do so would be outwith the Statement of Financial Entitlements. National suspension and income protection of QOF and IIF would require a consultation on patient impact (usually minimum 12 week period) unless we were in level 4 national incident measures and were able to point to specifics which general practice would be delivering as a result of income protecting funding
Commissioners may however further support general practice and primary care over the forthcoming winter period by taking reasonable actions including:
- Where local schemes, which are not part of the national contract, are being commissioned, and these are not part of providing additional capacity or services which are part of the response to winter pressures, commissioners should consider where these could be suspended or dialled back (with income protection), particularly where these add significant reporting layers on general practice and other primary care providers. Commissioners should consider the reporting requirements of all locally commissioned services.
- Where already contractually allowed, commissioners should consider how to appropriately apply discretion over meeting targets. For example, the Medications Review and Medicines Optimisation service under the Network Contract DES requires PCNs to deliver a volume of Structured Medication Reviews in line with their clinical pharmacist capacity, with reasonable efforts shown by the PCN. In such circumstances, NHSE supports commissioners in working with general practice to identify where capacity has been used to meet access pressures.
To support with wider pressures, systems could consider bringing in additional capacity over the upcoming Bank Holidays when general practice is closed (as is contractually allowed). Equally, any enhanced service capacity which would have usually been offered on Sunday 25th, Monday 26th or Tuesday 27th December and Monday 1st January will not be available unless otherwise agreed, with PCNs required to provide this at another time within 2 weeks of the dates. Systems may also wish to consider securing additional capacity through the established flexible digital staffing pools.
Commissioners should consider how the wider primary care system can support the management of patients, for example community pharmacy”