GPs in England will be handed £250m to improve their services but only if they increase the number of patients being seen face-to-face under a new government and NHS action plan. The move follows an increasingly heated public war of words between GPs and health secretary, Sajid Javid, who has told family doctors to ramp up in-person consultations. Under the “blueprint” GP practices in England will be able to share in a new £250m “winter access fund” to hire more staff, such as locum GPs, physiotherapists and podiatrists. However, the money will be conditional on increasing the number of patients who get an in-person appointment. In future, GPs must ask patients if they want to come into the surgery to be seen or are happy to talk to a doctor or practice nurse on the telephone or by videocall instead and arrange a face-to-face consultation if that is what the patient wants. NHS England made clear that “every GP practice must seek patients’ input and respect preferences for face-to-face care unless there are good clinical reasons to the contrary”. Exhibiting symptoms of Covid-19 will be the most common clinical justification for refusing to see a patient in person, with most others offered a physical interaction, NHS sources said. Ministers and NHS England have made clear to GP organisations during recent discussions about the new package of measures that surgeries will also have to provide more on-the-day appointments, especially to those in urgent need. There is evidence that the difficulty of getting to see a GP is one of the factors driving the recent rise in people seeking care at an A&E unit. Only surgeries that provide “appropriate levels of face-to-face care” will be able to apply to the new fund for money to expand access to care. Those that fail to expand in-person treatment will be “offered support to improve” under a more rigorous regime of scrutiny of how they operate. From next spring data will be published every month showing what proportion of each surgery’s appointments occurred in person or virtually, in what GPs may see as a “name and shame” exercise. The government is also set to scrap the 2-metre social distancing rule in GP surgeries to pave the way for more patients to be able to come in, bringing them into what is already the policy operated by hospitals. The move will be outlined in new guidance on infection control procedures drawn up by the UK Health Security Agency which is due to be published imminently. Javid has heeded some suggestions made by GP leaders by agreeing that they should write fewer “fit notes” for people who are off work sick and also undertake fewer DVLA checks. But he has disappointed the British Medical Association and Royal College of GPs by rejecting other ideas they proposed to reduce their workloads. They included suspension of the Quality Outcomes Framework, under which GPs are paid for monitoring patients with conditions such as asthma and diabetes; creation of a new national helpline to answer patients’ queries about Covid vaccination; and ensuring that hospitals set up systems to let patients know when their planned surgery is happening, to reduce calls to GPs about that. The BMA warned that the shake-up would make it harder rather than easier for patients to get appointments. “After weeks of promising an ‘emergency package’ to rescue general practice, we’re hugely dismayed that whilst additional funding has been promised the package as a whole offers very little and shows a government completely out of touch with the scale of the crisis on the ground”, said Dr Richard Vautrey, the chair of the BMA’s GPs committee. “GPs and their teams will now be facing the worst winter for decades, and as a result, patients’ care will suffer. Appointments will be harder to book, waiting times will get longer, more of the profession could leave and GPs will struggle to cope. “It is also disappointing to see that there is no end in sight to the preoccupation with face-to-face appointments; a more intelligent conversation about the variety of appointments and care that are available to patients to meet their needs,” Vautrey added. “The pandemic has proven that in many other cases phone or video appointments are entirely appropriate and appreciated by patients, and a crude focus on percentages or targets is completely unhelpful.”