The Director
of Primary Care Transformation (DPCT) and the Clinical and Care
Director (CCD) Barking and Dagenham at NHS North East London (NEL)
delivered an update on enhanced access. The presentation detailed
that:
- All Primary Care Networks (PCNs) in England would be required to
offer patients a new ‘enhanced access’ model of care
from 1 October 2022, which would see GP practices open between
6.30pm-8pm from Mondays to Fridays, and between 9am and 5pm on
Saturdays. This would replace the current Extended Hours
and Extended Access services, marking a shift in the way
out-of-hours non-urgent services were provided across North East
London.
- The PCNs had subcontracted and were working alongside the GP
Federation to provide these services. As part of the NHS England
(NHSE) specification, the PCNs were also working alongside new
roles funded by the NHSE, such as clinical pharmacists,
physiotherapists and occupational therapists.
- To
support PCNs with engaging their patients, NHS NEL had run a North
East London-wide survey on provided services, of which there were
just under 5,000 responses from Barking and Dagenham
residents.
- The model would evolve as ongoing resident feedback was
received, as well as to cater to the needs of patients.
- A
mixture of GP, nurse and therapist services would be offered, as
well as face-to-face, telephone and remote
appointments.
- The new model would run from three sites locally.
- Additional funding had also been secured to keep the current GP
Access Hub service running until 31 March 2023.
In
response to questions from Members, the DPCT and the CCD stated
that:
- The model would be flexed to accommodate the various preference
types for appointments and the PCNs would continue to work with
patient groups, to suit their needs. NHSE had also specified that
PCNs needed to provide a range of appointment types.
- When patients booked an appointment, they would be asked which
type of appointment they wanted; if a patient wished to have a
face-to-face appointment, it would be offered to them.
- They would return to the Committee early in 2023 once the
service had been running for a few months, to bring back data and
feedback from residents as to the new services offered.
- Whilst there was already an existing weekend and evening service
for urgent appointments, the ‘enhanced access’ model
would be for routine appointments and would increase GP opening
hours for these.
- It
was estimated that around 72,000 additional appointments could be
undertaken each year through the six PCNs in Barking and Dagenham
working together, as part of the “enhanced access”
model. NHS NEL would ensure that the current in-hours offer would
not reduce due to this, and could bring back data on the number of
appointments provided in the first quarter, upon their return to
the Committee in January 2023.
- It
was hoped that the model would increase the uptake of screening
programmes, for those who were only able to book after-work
appointments.
- NHS NEL was in discussion with Council colleagues about the
Borough’s Family and Children’s Hubs, and services that
could be provided in these. It was looking to be cost-effective by
using existing sites to provide services; however, it was looking
to expand these. The DPCT would feed back comments around Marks
Gate and potential access issues for these residents, if services
were only provided from BCH and Parsloes Avenue.
- The current in-hours offer with each GP practice would remain,
with the extended hours being provided by GPs working alongside the
wider primary care family. 12 new roles had been funded by NHSE, so
that a blended team could work within the new service and best meet
the needs of patients. As patients often still wanted to see their
GP, the support of the Committee was requested in promoting the new
service and additional staff, as it was important that patients saw
the right clinician for their needs, and that GP time could be best
utilised for those patients with the most complex
issues.
- In
terms of measuring the performance of the six PCNs, NHS NEL could
look at various measures, such as how many residents had received
annual diabetes checks. The quality of services could also be held
to account via Quality and Safety meetings, with data able to be
pinpointed to PCN and practice-level and plans able to be created
to improve services and increase uptake. NHS NEL was also working
with the GP Federation from an equality perspective, to look into
how many appointments would be available for each GP practice, to
ensure that these were not all being taken by patients from a
single practice.
- Patients with LD could be catered for through longer
appointments and at certain times of the day, when practices were
less busy. A lot of learning from the vaccine campaign, whereby
clinics for those with LD were run, with amended and quieter room
settings, was also being fed back to those developing the
‘enhanced access’ service.
- In
most GP practices, reception staff would triage patients, to ensure
that they were seeing the correct clinician for their ailment, and
they were well trained to do this. However, clinicians would triage
patients with more urgent needs.
- GP
practices were working towards holding 70 percent of appointments
face-to-face. The remaining 30 percent of appointments were held
via E-Consult, as part of a national directive, as well as directly
bookable slots via the 111 telephone number.
- The ‘enhanced access’ service would hopefully reduce
the number of patients going to accident and emergency services
(A&E), as they would instead have access to extended hours GP
services.
The
Cabinet Member (CM) for Adult Social Care and Health Integration
stated that she was co-chair of the new partnership board, which
included members from Health, the Local Authority and the Voluntary
and Community Sector, and that she would be looking to see new
metrics around issues such as health checks and the quality of
services. The Director of Public Health noted that the new
‘enhanced access’ model would be very positive in
improving the outcomes for residents who were unable to access
current GP services due to issues such as their work
schedules.
It
was requested that the Committee be provided with a thematic
analysis of the complaints that were being received about the PCNs
and the new ‘enhanced access’ service. The DPCT stated
that complaints data about the ‘enhanced access’
service could be brought as part of the January 2023 Committee
update, but that she would circulate some information regarding
practices and PCNs, following the meeting.