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NHS England has issued the new GP contract, which includes plans for increasing patient uptake of online services, switching off paper referrals and delivering a new GP data service.
As part of the contract, GP practices are required to reach 100% uptake of NHS England’s e-referral service (e-RS) by October this year, completely stopping using paper referrals.
However, the contract said that NHS England will be “supportive” and won’t take contractual action should practices not achieve this – unless it’s a last resort.
“Where a practice is struggling to use e-RS, there would be a contractual requirement to agree a plan between the practice and CCG to resolve issues in a supportive way as soon as possible,” the contract said, adding that GPs won’t be penalised if it’s not fully implemented due to services not being available to refer into, “or or IT infrastructure is incapable of delivering an effective platform”.
“These system-wide issues will be dealt with, including listening to and working with practices and GPs in the area who will be kept involved in agreeing any revised paper switch off date,” NHS England said.
The roll-out of e-referrals began in 2015, but uptake has not been as quick as expected. By March 2016, 50% of patients were referred for hospital appointments using the system, and as of December 2017, 62% of referrals were made using the system. The government is now on track to make its target of 100% by the end of 2018.
“While the majority of practice referrals are now already being made by e-referral, NHS England is aware there is still concern from some GPs about aspects of e-RS roll-out and the implications for practices,” the contract said. “Therefore, a major part of the implementation approach will be to work with local systems, including those practices, to clarify this, resolve the issues and support their adoption of e-RS.”
As part of the contract, GPs are also tasked with increasing the number of patients using the practices’ online services. Although most GP practices have been offering online access to medical records, and allowing patients to order repeat prescriptions online for years, uptake has been very low.
In May 2015, uptake was as low as 0.4% – a figure which had risen to 2% by September 2015. Figures still haven’t improved much, and NHS England is encouraging practices to drive uptake.
“There will be a contractual change so practices that have not achieved a minimum of 10% of patients registered for online services – online ordering of repeat prescriptions, online appointment booking or online access to patient records – will work with NHS England to help them achieve greater use of those online services, the contract said.
It added that NHS England has agreed a non-contractual change to “guidance that will promote uptake of patient use of one or more online services to 30 per cent including, where possible, applications to access those services and increased access to clinical correspondence online”.
New GP data service
The contract also mentions moving away from the GP Extraction Service (GPES), which was branded a failure by the Public Accounts Committee in 2016.
Work on the GPES programme, set up by the Department of Health and the now-defunct NHS Information Centre (NHS IC) to collect data from the clinical systems of 8,000 GP practices in England, was originally due to start in 2010.
The data was intended to be used for a variety of functions, such as quality management and the controversial, and now scrapped, Care.data project to create a central database of anonymous patient records for research and analysis purpose.
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The system has been run by NHS Digital since 2013, when it inherited it from the NHS IC in 2013.
NHS England said it is working with the BMA General Practitioners Committee to develop a framework for a new GP data service as a replacement for GPES.
“The new service will improve capacity and functionality, reduce cost burdens and ensure data collection is appropriate and meaningful. It is anticipated that any new system will be operational from 2019/20 at the earliest,” the contract said.