Using a system such as Doctor First reduces the need for employees to take time away from work. We've found employers are happy to provide private space for a quick phone call saving time for both employee and employers.
If patient needs face to face an appt is booked with out question either same day or around work requirements.
We have worked with many amazing GP Practices that have transformed the way they work Monday to Friday and now help all patients wanting help on the day they need it. These GP practices report that working this way has reduced the need for extended hours to almost zero.
Yet the reporting mechanisms set up now will have them reporting no access to pre bookable appointments for extended access. Totally missing the point that they are helping all patients on the day that they need it, whilst reducing demand for OOH and A&E services.
If the politicians took note of what worked we might all be in a better place.
I agree something needs to happen to help control GP workload but not sure this is the answer. How do you define when a GP is 'full'?
If you set the limit at 40 contacts per day this could easily be gamed by practices where 30 of those 40 could be follow ups, pre books and self selection by clinicians. In terms of actual patients needing help per day patients could end up never seeing their GP but instead referred to hubs. 'Oh sorry I have my 40 pts booked for today, can you jog onto the hub please...'
Every practice/area will have a variation in GP workload and local assessment needs to happen to baseline what GP practices are delivering in terms of appts and what they can potentially deliver in terms of working differently. CCGs/Federations can then plan intelligently for the shortfall in General Practice with hubs providing this service on the days and areas required. (If required).
What patients would need to realise is that 7-day care would not resemble the current 5-day GP system. GP of choice won't be working Saturday and Sunday and then Mon-Fri. So continuity won't be improved by stretching the service.
We work on addressing the in hours system and enabling GP practices to manage care safely within these hours. Only then once this system is stable can we think about designing systems outside core hours to support the in hours service.
Maybe now we can concentrate on putting funding into core hour services and making them fit for purpose? There is so much variation in the productivity of practices during core hours. I don't know how CCG's have managed to effectively identify un met demand and then plan appropriate services for weekends and 7-day working. I am not surprised by these findings.
I don't get this initiative being described as a 'new way of working'. Isn't it just more of the same way of working? I'm not knocking it, if it works and you have the money to spend on this then great! But it's not innovation. Off track but...Chelsea FC had a problem when Roman Abromovich took over the club in that they hadn't won a league title for many years, but he didn't change the system he just threw more money at the problem and in the end it worked...short term. For Chelsea also see Man City! None of them have continued success by simply throwing money at the problem. To sustain this they are looking at development of youth etc a change in system development. Thats what the NHS needs to do...change systems not extend hours!
We have worked with a practice in Salford who have achieved much higher reductions in A&E by addressing the 'in hours' system and changing the pathway within General Practice to make it much easier for patients to access clinicians. They recently got an 'outstanding' award from CQC. A case study is attached for information.
if you would like to know more about this service we have Dr Nikki Burger presenting on this at our free to attend 'Innovations in Practice' event on May 1 at King Power Stadium, Leicester. Free only for GP/CCG staff.
You can register here..http://www.productiveprimarycare.co.uk/event-registration.aspx
As a patient this doesn't inspire me with confidence. As a professional in this arena it scares me even more that we are providing a service that is just not sustainable.
With a crisis in GP recruitment looming/present how can we provide more? One way will be (as with extended hours) to take the capacity out of in hours and move it to 6.30- 8pm etc. This will drive an unnecessary demand to these services making them look like a success as patients struggle to access 'in-hours'.
The Government will hail this a a wonderful solution and with an election on the horizon this will be used to mislead voters. Oh by the way they will then tell CCG's to fund this.
Why don't they look currently at what in hours appointments are offered by GP practices. Then try to reward the activity in hours along with innovative ideas to meet this?
I fear for the future of General Practice as it is now...
This is a great article looking at how one small practice has tackled their problem of access and demand management.
I am the Director at PPC Ltd who operate the Doctor First system and overseen the successful implementation across many practices in UK. We are impressed with Heather's practice in both their 'can-do' attitude and willingness to succeed.
Even braver is putting the story on a 'peer support' domain to share their journey. Many comments are supporting and understanding of how difficult it can be to bring about change in General Practice.
Other comments are far from the truth (Hunt vision?!) and I would gladly spend time explaining this if they wish.
One final comment to Anon 10.50- if you want/need to see a pt face-to-face you do, so no skills are eroded but you see the patients that need seeing. See them all if you want- but patients given the choice won't want to see you if they don't have to.
Well done Heather!