In December 2013, NHS England invited GP practices to submit expressions of interest to be a pilot site for the Challenge Fund. Over 250 expressions of interest were received by local NHS England teams from groups of practices throughout England. The expressions of interest were assessed against the following seven criteria:

1. public and patient engagement – reflecting the local communities’ priorities on accessing primary care;
2. sustainability – this included ideas for how to make the scheme continue beyond the pilot phase;
3. scale and ambition – likely to cover populations of at least 40,000 people;
4. leadership and commitment – clear engagement from all the practices involved;
5. link to local strategy – putting general practice at the heart of integrated out-of-hospital care, addressing health inequalities;
6. capacity for rapid implementation – delivering tangible patient benefits during 2014/15 and beyond and
7. robust plans for monitoring and evaluation – mapped against clear success criteria.

The local NHS England teams reviewed the expressions of interest and assessed them against the above seven criteria. The best ones were then submitted to a national assessment panel that included patient representatives, and senior NHS England, Department of Health and Clinical Commissioning Group representatives. A further evaluation was then conducted based on the seven criteria and an assessment on which expressions of interest would have the greatest effect on patient services in their area.

Twenty GP collaboration sites were awarded money from the Challenge Fund in April 2014 and an outline of their pilots can be viewed on the NHS England website. The money was not shared equally; it was allocated depending on the size, scope and development needs of each initiative. The smallest amount received was £448,000 with the largest amount being £5,609,000. The funding was for one year to help practices test these new ways of delivering services and extending access, while making sure services are sustainable beyond the first year.

Sites started to pilot the new and innovative services from April 2014 and over seven million patients across England were expected to benefit from the pilot schemes.

On 29th October 2014, GP practices were invited to apply to take part in the second wave of the Prime Minister’s Challenge Fund. For the 2015/16 period, there was funding of £100m for GP practices who could demonstrate how they would use the money to improve and extend patient access to services, with priority being given to places where GP practices are opening longer such as 8am-8pm, seven days a week.

GP practices were required to submit their applications by 16th January 2015 and a total of 156 applications were received. Applications were assessed by local NHS England teams who then submitted the best proposals to a national assessment panel to make the decision on who was awarded funding.

On 27th March 2015, NHS England announced that 37 applications, covering 1,417 practices had been selected to lead the way in the second phase, testing innovative ways of increasing access and delivering wider transformational change in general practice. 

The types of innovative GP services that were being offered included:

• extended opening hours, so patients could be seen early in the morning or in an evening, with some areas bringing together practices to work as hubs;
• ability to make GP appointments via other routes, such as urgent care centres, walk-in centres or A&E;
• ability to make GP appointments, order repeat prescriptions, obtain health advice and information using smartphone apps;
• having phone, video link, email or face-to-face appointments with GPs;
• free text messages to promote wellbeing and to remind patients about routine health checks;
• creation of specialist roles or a team of specialists to manage patients with complex long-term conditions or frail, older patients;
• GP-led phone based triage system; and
• community navigators who provide health guidance to patients rather than medical care and signpost patients to relevant support groups and organisations. 

A number of the pilot sites included community pharmacy within their proposed plan to make services more accessible to patients. PSNC supported networking and information sharing between the LPCs in these areas.

Some of the projects that LPCs worked on included:

• introduction of new services in their area, such as winter ailments service, minor ailments service and/or an emergency supply service;
• creation of a new pharmacist role ‘Pharmacy Services Coordinator’ who worked with staff in GP practices and community pharmacies (Pharmacy Services Co-ordinator Job Description);
• involvement in the AQUA project that involved identifying high risk vulnerable patients. Identified patients received a visit from social care and a Medicines Use Review (MUR) was undertaken by a pharmacist in the patient’s home (the two visits are ideally coordinated so they happen on the same day). The pharmacist then phones the patient after a length of time (similar to a New Medicine Service follow up call) if the patient has issues following the MUR;
• creation of a new pharmacist role ‘Care Network Pharmacy Lead’ who championed the role of pharmacy and supported the integration of pharmacy into care planning (Care Network Pharmacy Lead – Expression of Interest); and

involvement in the EPIC (Extended Primary Integrated Care) project in Brighton, where pharmacy was integrated into first line treatment in the primary care team. The patient phoned their practice for triage by a GP and they decided whether the patient should be referred to a pharmacy or whether they need to see another healthcare professional. If the patient is referred to the pharmacy, the patient was given a 15 minute consultation with the pharmacist. The list of conditions that could be referred to the pharmacist were been agreed and Patient Group Directions were in place to support this. There are three levels to the pharmacy element:

• level one – all pharmacies could offer this service, which included dealing with medicines queries and reviews. These patients could either be referred by a GP or be walk in patients. All pharmacies involved in the EPIC project had access to GP records;
• level two – this occurred following GP triage where the patient is referred by the GP; appointments were booked at the pharmacy using an electronic system. The consultations  involved the management of a specified list of conditions (approximately 12) and where appropriate the supply of medicines through PGDs; and
• level 3 – this was provided by community pharmacists with independent prescribing rights and involved a wider range of patients and medicines. It was also planned to include long term conditions (including hypertension) in due course. Level 3 was restricted by the number of independent prescribers and the number of appointments available.

A video on the EPIC project, which explains the different elements of the service is also available.

LPCs who were located in an area where GP practices had become pilot sites were invited to participate in a teleconference on 23rd March 2015 to share information on pharmacy involvement in the Challenge Fund projects in their area. Challenge Fund Teleconference minutes 23rd March 2015

The document, Mapping of sites to LPCs, has been created to map the Prime Minister’s GP Access Fund sites and other current NHS initiatives to LPC areas.