Enhanced Access Implementation:
A more detailed and broader FAQs will follow shortly.
Can a PCN opt out of part of Network Contract DES e.g. the Enhanced Access (EA) service?
When a practice signs up to the Network Contract DES, all elements of the DES must be provided. A PCN cannot opt out of any part of the DES or offer a reduced service including for the enhanced access service. The PCN may choose to sub-contract delivery of the EA service to another provider if it wishes to do so.
Is there any flexibility in how a PCN provides the capacity?
We understand that flexibility in the service is important so that services can be tailored to meet the needs of the local population. The EA service requirements are intended to allow PCNs the ability to understand what their patients need and design the EA service accordingly.
It is also down to the PCN to determine, based on patient engagement:
- the exact mix of in person face-to-face and remote (telephone, video or online) appointments,
- how many appointments are for emergencies, same day or pre-booked (including screening, vaccs and imms) and
- which services should be available when and what skillmix is needed to deliver these.
There is additional flexibility in allowing a proportion of EA capacity to be provided outside Network Standard Hours e.g. on Sundays, or early morning 7am-8am depending on patients’ needs and preferences. There is also flexibility for some capacity to be provided during core hours, where it is agreed with the commissioner that this is necessary due to regular high demand during core hours.
Does the service have to cover the whole Enhanced Access time period? Or does it just have to take place at times between those hours?
The new Enhanced Access arrangements aim to offer a more nationally consistent and better understood offer to patients. From 1 October 2022, a PCN must provide Enhanced Access to cover the hours of 6.30pm and 8pm Mondays to Fridays and between 9am and 5pm on Saturdays. This means that it would be reasonable for a patient to be able to expect an appointment during these periods. PCNs are able to weight their Enhanced Access capacity* (with commissioner approval) to where it is most needed, e.g. more appointments may be offered at busy times, or before 8am, on a Sunday, or during core hours.
*based on the number of minutes of EA a PCN must provide each week using the formula of 60 minutes per 1000 PCN Adjusted Population patients
What GP cover is required in the network standard hours?
In terms of GP availability, GP clinical cover should be provided across the Network Standard Hours as part of a wider multi-disciplinary team (MDT) to ensure that an appropriate blend of remote and face-to-face consultations can be provided in line with clinical needs and taking account of population demographics.
PCNs must ensure appropriate clinical cover and supervision are always in place for the multi-disciplinary team. This may be delivered by the appropriate clinician and may be offered remotely where there is more than one site in operation.
How are the 60 minutes/1000 patients made up?
The DES sets out the specific things which a PCN needs to consider in their EA service, including that it must be:
- a mixture of in-person face-to-face and remote (telephone, video or online) appointments, provided that the PCN ensures a reasonable number of appointments are available for in-person face-to-face consultations to meet the needs of their patient population, ensuring that the mixture of appointments seeks to minimises inequalities in access across the patient and
- delivered by a multi-disciplinary team of healthcare professionals employed or engaged by the PCN’s Core Network Practices, including GPs, nurses and Additional Roles and other persons employed or engaged by the PCN to assist the healthcare professional in the provision of health services and
- may be for emergency, same day or pre-booked appointments
Within those parameters there is scope for PCNs to tailor their service offer to meet patient need, including length of appointment time.
PCNs will need to utilise population health management and capacity/demand tools as well as looking at local data together with seeking the views of patients as they develop their service.
In developing that service offer, PCNs need to agree with the commissioner what service mix would best meet the needs of their patient population, and they should be able to show how recent patient engagement has informed their proposals.