Agenda item

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.