This programme established local GP hubs to increase capacity, improving patient access and generating financial savings.
Background
The system comprises 30 GP practices organised into seven primary care networks (PCNs) covering a population of circa 350,000. The A&E department is based at the Royal London Hospital, Whitechapel under the management of Barts Health and the Urgent Treatment Centre which is on the Royal London Hospital Site is under the management of the local GP Federation
Aim
The aim of the programme was to establish local GP hubs to provide additional GP primary care capacity, in the form of booked appointments, during core hours to receive patients:
a) redirected from NHS 111
b) redirected from GP practices when practice same day slots were exhausted, and
c) streamed from the local A&E department
Approach
The Same Day Access (SDA) Programme Team worked with PCNs to establish three pilot Same Day Access Hubs across the borough, providing coverage for the entire population during the core hours of weekdays and at weekends.
The hubs were integrated with an existing separate seven-day borough service run by the local GP Federation that offered 30 appointment slots per day to receive patients streamed from A&E
Summary of PCN Hub Functions
Pilot Activities upstream of Royal London Hospital A&E
The pilots offered additional GP practice capacity for receiving patient redirections from NHS 111. This capacity provided was beyond the level that individual GP practices were required to provide under their GMS contract to accommodate patient redirections from NHS 111.
Results: an analysis of NHS 111 PEM data indicated that c66% of NHS 111 appointment demand for patients with a Primary Care Disposition had been managed by the practices and the pilot hubs (rising to 75-80% for the best performing hub and associated PCN member practices.) This Hub activity is estimated to result in the avoidance of c50 A&E attendances each weekday.
The pilots also provided appointments for patients when individual PCN member practices had no available same-day appointments.
Results: It is estimated that the Hubs’ provision of capacity during such times prevents c20 A&E attendances per weekday.
Pilot Activities downstream of Royal London Hospital A&E
The pilots offered GP capacity for receiving patients streamed from the Royal London A&E.
Results: Latest figures indicate an average of c100 patients (c20 per weekday) being streamed from A&E/UTC (urgent treatment centres) to the pilots. This is in addition to an average of c25 per day streamed to the existing borough service run by the GP Federation.
The Programme proved that 50-60 patients per day would be both suitable and willing to be streamed from A&E to a GP Hub Service. (Approximately 20% of the daily UTC activity)
Overall financial impact
We estimate that based on current data and full implementation of the service, the pilots are currently generating a net saving of £40,000 to £50,000 per month for the integrated care board.
NB: While the system has not experienced a reduction in A&E/UTC activity, the upstream functions described above are playing a role in containing growth in A&E/UTC attendances, which positively impacts patient waiting times at these services.
Non-financial benefits of the same day service
- The scheme offers c41,500 additional primary care appointments per annum (133 per day) to improve patient access to a same day primary care appointment, in their local area. If this were allocated to individual practice this would only be equivalent to c4.5 appointments per day. Much more has been achieved by creating a critical mass of appointment slots through the establishment of Hubs
- Where patients are booked into the Hubs by NHS 111 or local practices, patients are seen closer to home rather than attend A&E/ UTC.
- Patients do not have to wait in A&E/UTC but can have a booked appointment on the same day.
- Patients are seen by a local clinician with full access to their medical records.
- Patients receive a more comprehensive service than at A&E/ UTC. Hubs can order tests, make specialist referrals and act on clinical record flags e.g. to remind patient they are due health screening appointment
- Better links to social prescribers and other relevant primary care services
- Reduces likelihood of patient having to reattend their own GP practice following an A&E/UTC attendance saving clinical time and benefiting patients. An audit completed during the programme indicated patient reattendance rates following a pilot consultation at 5-10% compared with c40% following UTC attendance.
- Patient Survey feedback of the service has been very positive
- Improved relationships between GP PCNs, the GP Federation and Barts Health, forming good foundations for future collaborations, particularly integrated neighbourhood teams
The Future
This programme was a pilot and despite favourable outcomes its future is not guaranteed. However, we remain optimistic as the collaborating organisations have significantly invested time in the programme, and our data is showing positive outcomes
Jonathan Weaver, PCC associate.
Contact PCC to discuss how we can work to redesign care in your area enquiries@pcc-cic.org.uk.
