4.6 Extended Hours Access
4.6.1 Provision of extended hours access appointments is a requirement of the Network Contract DES from 1 July 2019. This is separate from the CCG commissioned extended access services in 2019/20. Where a commissioner is not satisfied that a PCN is delivering extended hours access in accordance with the requirements of this Network Contract DES specification then it may withhold payment as set out in Annex B to this Network Contact DES specification.
4.6.2 PCNs will be required to provide:
a. additional clinical sessions (routine appointments including emergency or same day appointments), outside of PCN member practices core contracted hours, to all registered patients within the PCN;
b. extended hours access appointments in opening hours which are held at times that takes into account patient’s expressed preferences, based on available data at practice or PCN level and evidenced by patient engagement;
c. an additional period of routine appointments that equate to a minimum of 30 minutes per 1,000 registered patients per week, calculated using the following formula:
additional minutes* = a network’s aggregate CRP** ÷ 1000 × 30
*convert to hours and minutes and round, either up or down, to the nearest quarter hour
**contractor registered population (CRP) will be determined at 1 April 2019.
(for a PCN with 50,000 registered patients this equates to a minimum of 25 hours per week);
d. extended hours access appointments by the PCN’s member practices, or subcontracted appropriately, in continuous periods of at least 30 minutes on a regular basis in full each week, including providing sickness and leave cover; and
e. a reasonable number of these appointments face-to-face, with the rest provided by telephone, video or online consultations or a mixture of these methods
4.6.3 PCNs will determine how the extended hours access appointments will be delivered as part of the Network Agreement. All PCN member practices will be expected to actively engage in planning of the service. The exact number of extended hours access appointments delivered from each member GP practice premises will be for the PCN to determine subject to complying with the minimum additional minutes set out in paragraph 4.6.2 above. Not every individual clinician or practice will be required to deliver a particular share of these appointments.
4.6.4 Extended hours access appointments may be offered with any healthcare professional or others working under supervision in the PCN.
4.6.5 PCN member practices must ensure that patients are aware of the availability of extended hours access appointments, including any change to published availability, through promotion and publication of the days and times of these appointment through multiple routes. This may include the NHS Choices website, in the practice leaflet, the practice website, on a waiting room poster, by writing to patients and active offers by staff booking appointments. Any cancellation of extended hours access appointments, including arrangements for re-provision (e.g. bank holidays) should be re-offered within a two-week period around the original appointments and all patients within the PCN must be notified. Commissioners will also consider how best to communicate extended hours access to their local populations by publicising information to help patients to identify which practices are offering appointments at given times.
4.6.6 PCN member practices will be required to inform patients of any changes to the pattern of extended hours access appointments, providing reasonable notice to patients.
4.6.7 If any PCN member practice is providing out of hours services to their own registered patients, they must offer routine extended hours access appointments in addition to the out of hours service.
4.6.8 Unless a GP practice has prior written approval from the commissioner, no PCN member GP practice will be closed for half a day on a weekly basis and all patients must be able to access essential services, which meet the reasonable needs of patients during core hours, from their own practice or from any sub-contractor. This means that unless a GP practice has prior written approval from the commissioner, all PCN GP member practices will not close for half a day on a weekly basis.
5. Network financial entitlements
5.3.4 Extended hours access appointments - payment of £1.45 per registered patient as at 1 January preceding the relevant year. For 2019/20 it is a payment of £1.099 per registered patient (equating to £0.122 per patient per month) under this DES for the period 1 July 2019 to 31 March 2020 reflecting the fact that the DES begins in July (and prior to this the stand-a-lone extended hours access DES covers the period 1 April 2019 to 30 June 2019). The payment will start from July 2019 and be payable on a monthly basis by commissioners, no later than the last day of the month in which the payment applies and taking into account local payment arrangements. Recurrent investment of £30 million has been included in global sum.
5.4 Payments due to a PCN being formed in-year after 30 June 2019, or where a GP practice signs-up and joins a PCN in-year, will be made on a pro-rata basis accordingly.
5.5 Commissioners will need to be satisfied prior to making the first payment that the PCN has met the requirements outlined in section 2 including that a data sharing agreement is in place by 30 June 2019 to support extended hours access delivery.
5.6 Commissioners will be able to reclaim payments on a pro-rata basis if a PCN member GP practice, which signed up to the Network Contract DES, cease participation in the Network Contract DES during the financial year. Any reclaim of payments will be made at the end of a financial quarter.
5.7 PCNs will only be eligible for payment where all of the following requirements have been met:
a. As set out in paragraph 4.4.1.
b. For workforce related claims, the PCN has met the requirements as set out in paragraph 4.5 for the relevant roles against which payment is being claimed. Payments can be claimed upon the commencement of the individual’s employment. Payment under the Network Contract DES, or any part thereof, will only be made if the PCN satisfies the following conditions:
i. The employing organisation (whether this be a PCN member or a third party) continues to employ the individual(s) for whom payments are being claimed and the PCN continues to have access to them;
ii. The PCN makes available to commissioners any information under the Network Contract DES, which the commissioner needs and the PCN either has or can be reasonably expected to obtain in order to establish that the PCN has fulfilled the requirements of the Network Contract DES specification;
iii. The PCN makes any returns required of it and does so promptly and fully; and
iv. All information supplied pursuant to or in accordance with this paragraph must be accurate.
c. For extended hours access related claims, the PCN has met the requirements as set out in paragraph 4.6.
Payment under the Network Contract DES, or any part thereof, will only be made if the PCN satisfies the following conditions:
i. The PCN makes available to commissioners any information under the Network Contract DES, which the commissioner needs and the PCN either has or can be reasonably expected to obtain in order to establish that the PCN has fulfilled the requirements of the Network Contract DES specification;
ii. The PCN makes any returns required of it in relation to the delivery of services as set out in the Network Contract DES and does so promptly and fully in keeping with reasonable requirements set by the commissioner; and
iii. All information supplied pursuant to or in accordance with this paragraph must be accurate.
5.8 Commissioners will be responsible for post payment verification. This may include auditing claims of the PCN (and its member practices) to ensure that they meet the requirements of the Network Contract DES. Where required, PCNs and/or their member GP practices will provide to the commissioner in a timely manner all relevant information and assistance to support assessment of compliance with the requirements of this service and expenditure against the Network Contract DES.
5.9 PCNs (and their member GP practices) will be required to adhere to current financial probity standards that are in place across the NHS, ensuring that the deployment of resources would stand up to wider scrutiny as an efficient and effective use of NHS funding. PCNs unable to provide sufficient information to substantiate claims may result in payments being withheld or reclaimed. Any payment being withheld or reclaimed would be proportionate to the information the PCN is unable to provide.
5.10 Administrative provisions relating to payments under the Network Contract DES are set out in Annex B.