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Dr Ivan Benett: ‘Be positive about seven-day access’

Sofia Lind speaks with the left-leaning CCG clinical director who has the PM’s ear on why Government plans for seven-day GP access are the only way to keep the NHS sustainable

Dr Ivan Benett does not look like a man about to visit Number 10. He is relaxed, unshaven and has long curly hair that touches his shoulders.

But he is talking to Pulse immediately before speeding off in a taxi to Downing Street outline his CCG’s plan for seven-day GP access to David Cameron’s special adviser.

It could make for an interesting meeting. Dr Benett is a straight-talking, left-leaning GP who insists he is only in the CCG business to ensure that the NHS remains a publicly funded service.

He says: ‘For me the absolute bottom line is the sustainability of the NHS. I believe very passionately in the NHS and anyone who has followed my career will know that. I am driven completely by a wish to see the NHS work.’

And he is a man of his word. Before becoming clinical director of NHS Central Manchester CCG, which coversa patient population of 200,000, Dr Benett was known for standing as a Pulse-backed independent candidate in the 2005 general election in protest at the then-Labour Government’s NHS reforms.

He says his message to Mr Cameron will be that the Government must allow CCGs to free up additional resources and experiment with new ways of working:  ‘Don’t be too restrictive on what individual places want to do, let them experiment with new ideas and see which ones work.’

He speaks to Pulse as his own CCG experiments with opening GP practices seven days a week – an idea that the Prime Minister and health secretary Jeremy Hunt have both made clear they intend to roll out nationwide.

Indeed, the Department of Health slipped up when it issued a press release last autumn hailing the ‘success’ of Manchester’s seven-day GP access scheme when the service at the time had yet to see a single patient.

Dr Benett balks at any suggestion that his CCG’s move to expand GP access was politically driven, though he says he was happy to see the scheme recognised by the DH. He says: ‘We were very pleased, but we weren’t driven by their policies. We were going to do this anyway. We were quite clear about this.’

He adds: ‘I believe that we may have influenced their policies rather than the other way around.’

Pioneering

Central Manchester was one of a group of Greater Manchester CCGs to win funding last year from NHS England’s £2m ‘demonstrator’ pot of money for pioneering new models of general practice.

The CCG has used this money to give 50,000 local residents access to GP services between 8am and 8pm on weekdays and for three hours on Saturdays and Sundays for routine and emergency appointments. The scheme has been running since before Christmas.

Not all practices are open during these extended hours. Practices are grouped into four locality areas, each covering eight to 10 surgeries and 50,000 patients. Each locality has a hub practice providing the extended hours appointments. When other surgeries in the locality are closed, patients are directed to the hub. The hubs have access to GP records from all practices in that locality. Eventually those records will also be shared with emergency and urgent care services, and GP appointments will be bookable directly via NHS 111 and out-of-hours services.

Dr Benett believes it is too early to predict demand for the expanded access appointments, but a similar scheme in Durham has seen 7,000 patients accessing GP services at the weekend in the first 11 weeks of its trial.

He says: ‘We will have to wait and see. But we believe we need to divert around one patient per 1,000 population per week from A&E attendance. I think that is reasonable.

‘That equates to about 50 extra appointments per week in each locality and that is provided for. On top of that, to manage long-term conditions out of ordinary hours we have commissioned another 46 appointments.’

CV

Age: 57

Home: Didsbury, Manchester. I live alone, and with friends and guests from time to time, including asylum seekers sometimes.

Family: Four children and one grandson.

Education: Manchester Medical School. Masters in medical science from the University of Birmingham and diploma in cardiology for GPSIs from Bradford University.

Career history:

1985-present: GP principal (salaried since 2012);

2005-present: GPSI in cardiology;

2010-present: clinical director for Central Manchester CCG.

Career highs:

• Awarded best contribution to a quality service at NHS Heart Improvement Conference 2010. • Protested against the Labour Government’s health reforms as Pulse’s independent election candidate in 2005.

• Introduced a GPSI cardiology service in Manchester.

Interests: Watching Manchester United, travelling, spending time with my family.

Wider plans

Dr Benett sees the extension of GP access as part of a wider project to ease the pressure on emergency and secondary care.

He says: ‘We have all the problems of any inner-city area, with a relatively deprived population and an increase in acute admissions and in A&E attendance. Those are two big challenges as well as the high mortality rate that goes with an inner-city population.

‘We primarily wanted to tackle those issues by developing primary care and that means building up the capacity and expertise in primary care but also offering patients a wider choice of availability of access to GP practices.’

The CCG is also investing in an education programme led by hospital specialist nurses to develop better skills at GP practices, a new nurse-led dementia action team and better collaboration between GPs and hospitals on end-of-life care.

Dr Benett says: ‘We have developed several schemes. We have done that by building on the practices that already have expertise, and also getting specialist nurses out of the hospital to work with practices that haven’t trained up to the local enhanced service [for dementia].’

The CCG is also looking at new ways of contracting GPs and hospitals to ensure they are working to the same goals, including aligning CQIN and LES incentives.

Dr Benett says: ‘We are starting to talk about so-called “alliance” contracts with secondary care hospital colleagues, whereby we share the contract with all providers across primary, secondary and community care so that we can enable that movement of activity to come out and be much closer to where patients live.’

Positive message

So what is his advice to other CCGs and GPs interested in seven-day working and record-sharing?

‘To be positive about it. I think we can do this. In fact we have to do it because otherwise the NHS is not sustainable, so we have to manage urgent care activity, particularly out of hospital and in primary and community care. We are just one of a few pilot sites trying out different ways to do it and time will tell whether that works.

‘But be positive because actually the alternative is very much more scary than anything else.’

And with that Dr Benett has to leave –to take his message to Whitehall.

Quickfire Q&A

Was the Health and Social Care Act good or bad for the NHS?

The health reforms offer the opportunity to invest in and develop primary care; however, they sometimes enforce the introduction of the market and non-NHS providers into health provision.

How did you vote in the last election, and how will you vote in the next?

I didn’t vote in the last election, and voted for myself in the previous one. My politics are more naturally of the left.

If you were health secretary for a day, what would you do?

I would complete the task of nationalising the health service, relieving GPs and others of the bureaucratic burden of independent contractor status.

How many Saturday and Sundays have you worked in the past three months?

I have not done face-to-face consultations at weekends for about 10 years, but am working as I write this on a Saturday.

If you weren’t a GP, what would you be?

A popstar, then a writer or poet –after my parallel career as a box-to-box midfielder with Manchester United.

Readers' comments (20)

  • Positively not in a month of Sundays.

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  • Ivan Benett

    Then you will open up the NHS to independent providers of extended and weekend hours. They will get the resource and you will be further squeezed. The trick, not fully explained in this piece is to expand the capacity in the workforce in Primary care, so more GPs, nurses (general and specialist) to manage more urgent care and long term conditions. It's a no brainer if you think about it. Individuals don't have to work more than they are, and indeed may be able to spend more time seeing patients and less time ticking boxes. Still I can see some people don't get it, but hopefully enough will.

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  • Harry Longman

    I think this is very interesting. I'm married to a doctor so I'm firmly committed to family time and I know the pressures of weekend shifts. But Ivan is saying something both profound (in terms of urgent patient need) and practical - we need to find ways to make this work, which are sustainable and which also protect the essence of local, relationship based general practice from other worse models based on on transactional thinking (NHS111, need I say more)

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  • Not too bothered about this either way.

    My main concern is when the funding gets pulled and it is suddenly thought of as a core service - as long as this is a CCG problem only I don't care.

    I also suggest Dr Bennett does a few weekend shifts himself if he doesn't want to be seen as a poacher turned gamekeeper.

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  • Ivan Benett

    I am happy to do weekend shifts and less during the week. It doesn't matter to me whether its Friday or Saturday. Those with children or partners that work during the work could flex their hours more. Practices opening longer hours really isn't about individuals working harder or longer, but getting more resources into Primary Care - more GPs, nurses and other practitioners. I don't want to worker harder and would not expect others to, unless they want to.
    By the way, I've have worked many many weekends, nights and long long days in my time. I remember being called a 3 am to see someone with toorthache! Don't worry I didn't go out. They'd already been to two casualties. Ah, the good old days.
    By the way, what time is it. I better head off home, early start tomorrow.

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  • Vinci Ho

    It is probably fair to say one should be open minded about anything . Everyone has one's aspiration and ambition.
    But remember the name of politics is a game of poker . You try to make your opponent believe what you want them to believe. They are doing the SAME to you.(unless you already surrender yourself).
    There is only a fine line between winning and losing. And also collateral damages could be enormous ........
    Kun Hey Fat Choi, happy Chinese New Year
    ( from a die hard LFC fan)

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  • Ivan Benett

    Well what can you say to a die hard LFC fan- oh yes- 21

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  • Vinci Ho

    Yes
    5 European Cups

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  • "But we believe we need to divert around one patient per 1,000 population per week from A&E attendance. I think that is reasonable. That equates to about 50 extra appointments per week in each locality."

    That is based on the belief that an appointment in primary care would replace an attendance in A&E. Even the most optimistic estimates and evidence from Darzi centres say that it will take more than one GP appt. Some would even suggest that the increase in demand created would cause A&E attendances to grow.

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  • Peter Swinyard

    Lots of "if we don't knuckle down and do this the private sector will". With what workforce? How? And at what cost?
    There is limit to the amount of NHS resource. The rather fatuous announcement of £50million at the Tory conference - not new money - just removed from elsewhere in the NHS - will not begin to cover the true costs of weekend opening.
    If something is urgent - there are already real GPs there working in OOH. If it is not, good, advanced access (try Patient Access) will deal with matters during the working week.
    Where are these extra GPs to come from? Where is the money to open the hub practices to come from (heat, light, staff, possibly security?)???
    And I can see the pressure on empty nesters like myself to work Saturday and Sunday as we do not have child-transport duties and perhaps our wives are not out to work all week - If two in household work and weekend working is imposed, the damage to GP family life is almost worthy of the European Court of Human Rights.
    Sorry, forgot. GP principals have no rights.....

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