The General Practitioner (GP) Forward View, published in 2016, set out plans to recruit an additional 1,500 clinical pharmacists into general practice by 2020/21.

Following a recent consultation, several changes have been made to the data processing and methodology for general practice workforce data back to September 2015. Figures produced under the old and new methodologies are not comparable and revised figures have so far been published for December 2017, September 2018 and December 2018 only. The remainder of the September 2015 to December 2018 data is planned for publication on 25 April 2019 and cannot be disseminated before this date. The number of pharmacists working in general practice in March 2019 will be published in May 2019.

The recently published five-year general practitioner (General Medical Services) contract included funding for the new Additional Roles Reimbursement Scheme, in Primary Care Networks (PCNs). PCNs will be guaranteed funding for up to an estimated 20,000 additional staff by 2023/24. This funds new roles for which there is both credible supply and demand. The scheme will meet a recurrent 70% of the costs of additional clinical pharmacists, physician associates, first contact physiotherapists, and first contact community paramedics; and 100% of the costs of additional social prescribing link workers. The scope of the scheme will extend gradually, reflecting available supply and funding. Funding will be available from July 2019 for clinical pharmacists through the scheme

Public Health England publishes cervical screening coverage by clinical commissioning group (CCG), which shows coverage by practice for the current period and the previous screening interval period of 3.5 years or 5.5 years. The information is available at the following link:

https://www.gov.uk/government/publications/cervical-screening-coverage-and-data

NHS England commissioners oversee services so that performance and trends can be monitored locally.

NHS England is accountable to the Secretary of State for Health and Social Care for how well it performs its responsibilities under the Public Health Functions Agreement including to commission high quality public health services, with efficient use of resources, seeking to achieve positive health outcomes and to promote equality and reduce health inequalities. Quarterly assurance reports, produced jointly by NHS England and Public Health England, include a performance indicator on cervical screening coverage rates.

In addition, a range of national statistics and other data on cervical screening including coverage rates at primary care and CCG levels is published by NHS Digital and is available at the following link:

https://digital.nhs.uk/data-and-information/publications/statistical/cervical-screening-programme

As part of the delivery of the General Practitioner Five Year Forward View, the National Health Service is investing more than £258 million to improve access to general practice. Patients are now benefitting from improved access to all routine appointments (including cervical screening), at evening and/or weekends.

The NHS Cervical Cancer screening programme saves an estimated 5,000 lives a year by detecting abnormalities of the cervix early and referring women for effective treatment.

The routine assessment and management of pain is a required competency of all healthcare professionals. Many patients with chronic pain can be successfully supported and managed through routine primary and secondary care pain management services. Approaches to treatment are not all pharmacological; education in self-management techniques to aid symptom control may also be appropriate for some patients.

The National Institute for Health and Care Excellence (NICE) is currently developing guidance on the assessment and management of chronic pain aimed at all settings in which National Health Service and local authority commissioned care is provided. The guidance is expected to be published on 19 August 2020. Guidance scope for the NICE clinical guidance document in development can be found via the following link:

www.nice.org.uk/guidance/gid-ng10069/documents/final-scope

The routine assessment and management of pain is a required competency of all healthcare professionals. Many patients with chronic pain can be successfully supported and managed through routine primary and secondary care pain management services. Approaches to treatment are not all pharmacological; education in self-management techniques to aid symptom control may also be appropriate for some patients.

The National Institute for Health and Care Excellence (NICE) is currently developing guidance on the assessment and management of chronic pain aimed at all settings in which National Health Service and local authority commissioned care is provided. The guidance is expected to be published on 19 August 2020. Guidance scope for the NICE clinical guidance document in development can be found via the following link:

www.nice.org.uk/guidance/gid-ng10069/documents/final-scope

Respiratory disease is a clinical priority within the recently published NHS Long Term Plan. The Plan has the overarching objective of improving outcomes for people with respiratory disease, including asthma.

NHS England supports the national asthma audit programme that provides data on a range of indicators to show improvements and opportunities for further improvements in asthma outcomes.

The recently published general practitioner (GP) contract has made improvements to the Quality and Outcomes framework through the introduction of quality improvement modules. This replaces the current system of exception reporting with a personalised care adjustment approach, which will better reflect individual clinical situations and patients’ wishes. NHS England and GPC England have agreed to an ongoing programme of indicator review in key priority areas, including asthma in 2019/20. Through the GP contract and Primary Care Networks, clinical pharmacists will take responsibility for the care management of patients with chronic diseases and undertake clinical medication reviews to proactively manage people with complex polypharmacy, and those with multiple long term conditions, in particular people with chronic obstructive pulmonary disease and asthma.

National programmes such NHS RightCare are using leading edge medical evidence and practical support to help local health economies to make best use of their resources and using tested evidence based processes to make sustainable improvements to patient care. As part of this programme, a RightCare asthma pathway will be published in the spring which will outline the optimal pathway for patients, including the need for follow-up appointments following emergency care.

The current Alternative Provider Medical Services provider has given notice to terminate their contracts. NHS Liverpool Clinical Commissioning Group is now working with primary care providers in Liverpool to identify an alternate provider or group of providers, that may include an existing General Medical Services contract holder, to run the affected services to ensure continuity for patients.

NHS England’s Primary Medical Care Policy and Guidance Manual (first published 15 November 2017) provides local commissioners of primary medical services the context, information and tools to safely commission and contract management primary medical care contracts.

There is no prohibition on issuing General Medical Services or Personal Medical Services contracts under this guidance and every local commissioner needs to consider each individual case on the basis of local circumstances that apply. Considerations will also need to factor appropriate legislation and NHS England’s Standing Financial Instructions.

Commissioners need to comply with their obligations under the Public Contract Regulations (“PCR 2015”) and the NHS (Procurement, Patient Choice and Competition Regulations) (No. 2) Regulations 2013 (“the NHS Regulations”). One of the impacts of these Regulations is commissioner should not unnecessarily restrict contracts to only certain kinds of providers. In practice this will mean the use of Alternative Provider Medical Services contracts in procurements.

NHS England’s Standing Financial Instructions additionally require all proposed clinical procurements for all types of revenue expenditure which last for five years or more, including options to extend clauses, must be submitted to and approved by the NHS England Commercial Executive Group before advertisement.

Whilst these considerations do not the use of General and Personal Medical Services contracts where appropriate and justifiable, these are likely to be exceptional.

As part of the NHS Long Term Plan, Parliament and the Government both asked the NHS to make consensus proposals for how primary legislation might be adjusted to better support delivery of the agreed changes set out in this plan.

NHS England’s Primary Medical Care Policy and Guidance Manual (first published 15 November 2017) provides local commissioners of primary medical services the context, information and tools to safely commission and contract management primary medical care contracts.

There is no prohibition on issuing General Medical Services or Personal Medical Services contracts under this guidance and every local commissioner needs to consider each individual case on the basis of local circumstances that apply. Considerations will also need to factor appropriate legislation and NHS England’s Standing Financial Instructions.

Commissioners need to comply with their obligations under the Public Contract Regulations (“PCR 2015”) and the NHS (Procurement, Patient Choice and Competition Regulations) (No. 2) Regulations 2013 (“the NHS Regulations”). One of the impacts of these Regulations is commissioner should not unnecessarily restrict contracts to only certain kinds of providers. In practice this will mean the use of Alternative Provider Medical Services contracts in procurements.

NHS England’s Standing Financial Instructions additionally require all proposed clinical procurements for all types of revenue expenditure which last for five years or more, including options to extend clauses, must be submitted to and approved by the NHS England Commercial Executive Group before advertisement.

Whilst these considerations do not the use of General and Personal Medical Services contracts where appropriate and justifiable, these are likely to be exceptional.

As part of the NHS Long Term Plan, Parliament and the Government both asked the NHS to make consensus proposals for how primary legislation might be adjusted to better support delivery of the agreed changes set out in this plan.

NHS England’s Primary Medical Care Policy and Guidance Manual (first published 15 November 2017) provides local commissioners of primary medical services the context, information and tools to safely commission and contract management primary medical care contracts.

There is no prohibition on issuing General Medical Services or Personal Medical Services contracts under this guidance and every local commissioner needs to consider each individual case on the basis of local circumstances that apply. Considerations will also need to factor appropriate legislation and NHS England’s Standing Financial Instructions.

Commissioners need to comply with their obligations under the Public Contract Regulations (“PCR 2015”) and the NHS (Procurement, Patient Choice and Competition Regulations) (No. 2) Regulations 2013 (“the NHS Regulations”). One of the impacts of these Regulations is commissioner should not unnecessarily restrict contracts to only certain kinds of providers. In practice this will mean the use of Alternative Provider Medical Services contracts in procurements.

NHS England’s Standing Financial Instructions additionally require all proposed clinical procurements for all types of revenue expenditure which last for five years or more, including options to extend clauses, must be submitted to and approved by the NHS England Commercial Executive Group before advertisement.

Whilst these considerations do not the use of General and Personal Medical Services contracts where appropriate and justifiable, these are likely to be exceptional.

As part of the NHS Long Term Plan, Parliament and the Government both asked the NHS to make consensus proposals for how primary legislation might be adjusted to better support delivery of the agreed changes set out in this plan.

The data requested is not available in the format requested.

NHS Digital started publishing monthly data on appointments in general practice in December 2018. Data is currently available between November 2017 and January 2019. A table showing the time between booking an appointment with a general practice and having the appointment (in days) for England and NHS North (Yorkshire and Humber) is attached. There are seasonal variations in the general practitioner appointment data therefore the most recent month for which data is available (January 2019) is presented as well as a 12-month average. NHS Digital’s data on ‘time from booking to appointment’ does not take into consideration that many patients will be appropriately booking ahead as part of the continuity of care they receive for long-term conditions.

We do not collect information for primary medical care practices about the cost of providing care to individual patients or cohorts of patients.

In 2015 the Government set the ambitious target to recruit 5,000 additional general practitioners (GPs) by 2020. It was double the growth rate of previous years, but it showed a commitment to growing a strong and sustainable general practice for the future. The government is still determined to deliver this commitment as soon as possible.

The recently published NHS Long Term Plan made a clear commitment to the future of general practice, with primary and community care set to receive at least £4.5 billion more in real terms a year by 2023/24, meaning spending on these services will grow faster than the rising NHS budget. Since the launch of the Long Term Plan, NHS England and the British Medical Association’s General Practitioners Committee have agreed a five-year GP (General Medical Services) contract framework from 2019/20. The new contract framework will be essential to deliver the ambitions set out in the NHS Long Term Plan through strong general practice services.

NHS England and Health Education England (HEE) are working together with the profession to increase the GP workforce in England. This includes measures to boost recruitment, address the reasons why GPs are leaving the profession, and encourage GPs to return to practice.

Last year, HEE recruited the highest number of GP trainees ever and the Targeted Enhanced Recruitment Scheme (TERs) is attracting GP trainees to parts of the country where there have been consistent shortages of GP trainees. Over 500 trainees entered the TERs scheme in 2016-2018 and a further 276 places are available in 2019.

NHS England has a number of schemes in place to reduce workload and improve working conditions for GPs and to support them to remain in the National Health Service including the GP Retention Scheme, the GP Retention Fund, the GP Health Service and the Releasing Time for Care Programme.

NHS England has also committed to further expanding community based multi-disciplinary teams and will provide funding towards up to 20,000 other staff in primary care networks by 2023/24. This builds on the non-GP clinical staff already working in general practice, and will mean bigger teams of staff, providing a wider range of care options for patients and freeing up more time for GPs to focus on those with more complex needs.

The Department does not collect this information.

NHS England is investing in initiatives to improve access to general practice as part of the GP Five Year Forward View. This includes access to all routine appointments, including cervical screening, at evenings and/or weekends.

Local authorities are responsible for commissioning public health services in their areas, which includes commissioning of sexual health clinics.

This information is not collected or held centrally.

This information is not collected or held centrally.

As part of the general practitioner (GP) contract negotiations there will be a process later this year to consider which issues should be included in the negotiating remit for the 20/21 GP Contract.

NHS England has considered the expansion of the service to Birmingham following initial concerns, in particular regarding access to immunisation and screening programmes for Babylon GP at Hand patients, and a solution has been identified. NHS England will now work together with NHS Hammersmith and Fulham and Birmingham and Solihull Clinical Commissioning Groups (CCGs), national screening services, and Babylon GP at Hand to mobilise the service and agree a start date.

General practice payments are made to practices according to their registered patient list size, so the funding for general practice care will follow the patients. NHS England will shortly engage on changes to out of area registration rules, some of the current payments to primary care providers and the mechanisms by which new providers can enter the market.

The new General Practitioner Contract Framework made two changes to the current payment system:

- the rurality index payment will be amended to apply to patients living within a practice catchment area only, rather than to all patients. This is to better reflect costs; and

- the London adjustment will be amended to apply to patients resident in London, rather than registered with a London-based practice

CCG allocations have been revised for 2019/20. Hammersmith and Fulham CCG’s allocation takes account of the increased list size of the GP at Hand practice, with the CCG’s funding growth determined by an assessment of the CCG’s fair share of overall funding and rules on the pace of change in funding allocations.

All patients registered with the Babylon GP at Hand practice are recorded as patients of Hammersmith and Fulham CCG.

Hammersmith and Fulham CCG have commissioned an independent evaluation of the Babylon GP at Hand practice. This will look at the impact of the service on patient experience, primary care workforce, use of other services, such as accident and emergency departments and walk-in centres, and system value.

Babylon GP at Hand will provide physical premises in both London and Birmingham for those patients who require a face-to-face consultation. Under the current GP of Choice Policy, the CCGs where ‘out of area’ patients live are required to ensure out of hours care and home visits can be accessed by those patients in their resident area if they need it.

NHS England has considered the expansion of the service to Birmingham following initial concerns, in particular regarding access to immunisation and screening programmes for Babylon GP at Hand patients, and a solution has been identified. NHS England will now work together with NHS Hammersmith and Fulham and Birmingham and Solihull Clinical Commissioning Groups (CCGs), national screening services, and Babylon GP at Hand to mobilise the service and agree a start date.

General practice payments are made to practices according to their registered patient list size, so the funding for general practice care will follow the patients. NHS England will shortly engage on changes to out of area registration rules, some of the current payments to primary care providers and the mechanisms by which new providers can enter the market.

The new General Practitioner Contract Framework made two changes to the current payment system:

- the rurality index payment will be amended to apply to patients living within a practice catchment area only, rather than to all patients. This is to better reflect costs; and

- the London adjustment will be amended to apply to patients resident in London, rather than registered with a London-based practice

CCG allocations have been revised for 2019/20. Hammersmith and Fulham CCG’s allocation takes account of the increased list size of the GP at Hand practice, with the CCG’s funding growth determined by an assessment of the CCG’s fair share of overall funding and rules on the pace of change in funding allocations.

All patients registered with the Babylon GP at Hand practice are recorded as patients of Hammersmith and Fulham CCG.

Hammersmith and Fulham CCG have commissioned an independent evaluation of the Babylon GP at Hand practice. This will look at the impact of the service on patient experience, primary care workforce, use of other services, such as accident and emergency departments and walk-in centres, and system value.

Babylon GP at Hand will provide physical premises in both London and Birmingham for those patients who require a face-to-face consultation. Under the current GP of Choice Policy, the CCGs where ‘out of area’ patients live are required to ensure out of hours care and home visits can be accessed by those patients in their resident area if they need it.

NHS England has considered the expansion of the service to Birmingham following initial concerns, in particular regarding access to immunisation and screening programmes for Babylon GP at Hand patients, and a solution has been identified. NHS England will now work together with NHS Hammersmith and Fulham and Birmingham and Solihull Clinical Commissioning Groups (CCGs), national screening services, and Babylon GP at Hand to mobilise the service and agree a start date.

General practice payments are made to practices according to their registered patient list size, so the funding for general practice care will follow the patients. NHS England will shortly engage on changes to out of area registration rules, some of the current payments to primary care providers and the mechanisms by which new providers can enter the market.

The new General Practitioner Contract Framework made two changes to the current payment system:

- the rurality index payment will be amended to apply to patients living within a practice catchment area only, rather than to all patients. This is to better reflect costs; and

- the London adjustment will be amended to apply to patients resident in London, rather than registered with a London-based practice

CCG allocations have been revised for 2019/20. Hammersmith and Fulham CCG’s allocation takes account of the increased list size of the GP at Hand practice, with the CCG’s funding growth determined by an assessment of the CCG’s fair share of overall funding and rules on the pace of change in funding allocations.

All patients registered with the Babylon GP at Hand practice are recorded as patients of Hammersmith and Fulham CCG.

Hammersmith and Fulham CCG have commissioned an independent evaluation of the Babylon GP at Hand practice. This will look at the impact of the service on patient experience, primary care workforce, use of other services, such as accident and emergency departments and walk-in centres, and system value.

Babylon GP at Hand will provide physical premises in both London and Birmingham for those patients who require a face-to-face consultation. Under the current GP of Choice Policy, the CCGs where ‘out of area’ patients live are required to ensure out of hours care and home visits can be accessed by those patients in their resident area if they need it.