CAIP 2024/25

This outlines the contractual position and LMCs advice to practices and PCNs in relation to the CAIP funding for 2024/25

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There are three components of the 2024/25 CAIP, collectively described (by NHS England) as the ‘Modern General Practice Model’, includes an online component that required all Primary Care Networks (PCN) member practices to confirm that their online consultation platform is available for patients to make clinical and administrative requests for at least the duration of contractual core hours, that is, 8am to 6.30pm on working days. 

Each of the three CAIP components result in an equal, separate, payment to PCNs, subsequent to the PCN Clinical Director (CD) confirming compliance. The way the CAIP payments are structured means PCNs will receive their full year payment for this CAIP component providing the PCN CD declares compliance by 31st March 2025. However, payment will, in those circumstances, not be made until quarter one (Q1) of the financial year 2025/26. 

If, collectively, member practices agree to declare compliance, the LMC does not recommend leaving this to the last day in March. If member practices believe the financial benefit does not cover the risks, then postponing this decision […] may be preferable. 

As colleagues will know, the newly announced GP Contract for 2025/26 will include a modified CAIP, with only two domains. One of these will continue to focus on ‘supporting Modern General Practice Access’ and comprises a national payment of £58.4 million. However, full details of the requirements of this domain are not yet available. 

More broadly, there is to be a six-month working period, until 1st October 2025, to implement the Governments commitment to an open online consultation platform for patients to submit administrative and non-urgent clinical appointment requests to practices during core hours, which is not how the 2024/25 online component of CAIP is defined. 

In summary, the LMC recommends those PCNs whose member practices wish to comply with the 2024/25 CAIP online component within this financial year make such a declaration by the third week in March. PCNs are then eligible to receive the 2024/25 CAIP payment associated with this component. 

How PCNs and practices approach the 2025/26 CAIP may depend on the details of this specification and payment arrangements, which should be available in April; practices should await further advice in relation to the 1st of October 2025 online Regulations since these will require considerable further discussion. 

Under the 2024/25 Contract Imposition, the Capacity and Access Payment (CAP) was split into two 70% was paid monthly to PCNs without conditions or reporting requirements. 

The remaining 30% was to be paid to PCNs on the basis of three separate, financially equally divided components, these being: 

  • Faster Care Navigation, assessment and response 
  • Better digital telephony 
  • Simpler on-line requests 

Together these form the three components of the CAIP and of what NHS England describes as the ‘Modern General Practice Model’. 

The online component requires all PCN member practices to confirm that their online consultation platform is available for patients to make administrative and clinical requests at least for the duration of contractual core hours, that is, 8am to 6.30 pm on all working days. 

The LMC simply does not believe that it is safe for practices, within an environment of increasing demand and/or limited capacity, to make this commitment. GP practices need to have flexibility in order to manage a safe workload, in the context of variable demand. It is also unsafe to allow online clinical issues to be submitted until 6:30pm, if practices are to manage their workload within core hours. 

The BMA Safe Working Guidance is creating a safe working environment for practice clinicians to deliver safe patient care: creating a preferential workload capacity for potentially unlimited online demand risks reducing practices ability to manage telephone and in-person demand, in the context of safely limiting clinician workload to an acceptable level. 

GPC England urged NHS England to recognise this concern during the 2024/25 Contract Negotiations and, as colleagues will recall, the contract was imposed without modification. The structure of CAIP payments means PCNs will receive their full payment for this CAIP component if PCN CDs declare compliance by 31st March 2025, although payment will not be received until Q1 financial year 2025/26. However, at £29.2 million across England, this represents about 35p per patient, and practices may conclude the risks of such an open-ended commitment exceed any financial benefits. 

It is not yet known whether current CAIP within the PCN DES will be rolled over, modified, or continue at all within the 2025/26 GP Contract. 

Current GMS/PMS Contractual Arrangements do not specify any period of time during which on-line consultations must be offered [Paras. 16.5.ZD1 to 16.5.ZD4], only that patients should have access to such a facility. 

The LMC encourages all PCN member practices to consider this point carefully, and collectively over the next few months.