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GPs buried under trusts' workload dump

GPs being funded to target 'frequent attenders' in bid to reduce workload

Practices are being funded for a scheme that will help them focus on reducing attendance their frequent attenders, and implement interventions to refer them to other services.

North Staffordshire and Stoke-on-Trent CCGs are implementing the 'Quick-start Programme' (QSP), which is being funded as part of NHS England's Time to Care programme and will be able to identify those patients that attend more than 20 times in a year. 

It will offer training to staff on how to review these patients and advise them on other interventions within a nine-minute appointment. 

The CCGs say that the programme should release 'hundreds' of appointments a year for a practice with an 8,000-9,000 patient list.

According to Primary care commission committee meetings from October last year, the project was proposed following a successful pilot in Bury from 2017.

Originally, an allocated £385k pot of funding from North Staffordshire and Stoke-on-Trent CCGs was budgeted, but according to Tracey Cox, Primary Care development lead for both CCGs, the NHS England Sustainable Improvement Team ‘have since supported this by offering cohorts locally free to access.’

This has allowed practices in the area to participate in modules over an 8-week period that will save time for both clinical and administrative staff.

Practices must require either the ‘frequent attenders’ or ‘appropriate appointments’ modules.

Typically, frequent attenders visit their GP between 20 to 40 times a year. The module will tackle this by using a GP practice's data to identify such patients and review the data to look for any errors i.e coding errors.

Then a multi-disciplinary team will show clinical and admin staff how to review each patient for a maximum of nine minutes to outline interventions on how to refer them away from GPs, such as social prescribing.

This module is delivered over 3 sessions, each lasting a half day. It is stated in NHS North Staffordshire CCG papers that depending on a practices' list size, a practice with 8-9,000 patient list size 'would likely be able to release hundreds of appointments per year, with many discovering inconsistencies between clinical practices for long term conditions.'

A study earlier this year found person-focused GP consultations could reduce frequent attenders.

The appropriate appointments module links practices to the national ‘avoidable appointments audit tool’ with the aim of allocating the right person to the patient.

North Staffordshire LMC chair Dr Paul Scott said: ‘This continues to be a very constructive and helpful programme that has allowed general practices to work smarter and develop some breathing space, in a background of ongoing GP shortages. North Staffordshire LMC fully supports its further roll out and its flexibility for practices to choose the modules that most suit their particular needs and challenges.’

Dr Chandra Kanneganti, a GP in Stoke-on-Trent and BMA GPC policy lead for NHS England investment, said he'd welcome this package because of the number of frequent attenders he sees in his own practice.

‘More and more, we see the same patients all the time. Having a proper plan for them and having some kind of resource that can treat those recurring patients will free up GPs valuable time so that they can concentrate on acutely and chronic patients.

'It’s not just A+E, there’s a number of frequent attenders in general practice as well. We have at least 10 to 15 patients who are frequent attenders and more often it’s not for medical reasons, it’s more for social causes, which a GP may not be able to support. Having a social prescriber, having a clear plan of supporting them, having that resource at the front end definitely will help GPs time.’

In just eight weeks of implementing the pilot in Bury, two hours of GP time a day were saved, 650 hours a year of admin time saved and there was an improvement in the practices CQC rating, according to a report by NHS England.

Meanwhile, NHS England is extending the Time for Care Programme after it recently reported that it has saved almost £40m worth of GP appointment time.

Readers' comments (7)

  • Done before doesn't work especially with the pittance the tories are chucking at primary care at the moment.The definition of insanity again doing the same thing again and again and expecting a different outcome.

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  • "Typically, frequent attenders visit their GP between 20 to 40 times a year. The module will tackle this by using a GP practice's data to identify such patients and review the data to look for any errors i.e coding errors.

    Then a multi-disciplinary team will show clinical and admin staff how to review each patient for a maximum of nine minutes to outline interventions on how to refer them away from GPs, such as social prescribing."

    That isn't why they attend frequently! And guess who'll get the time-consuming complaints?

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  • AL "4 TRIES IN ONE GAME" BUNDY

    How much do practices get per patient £60
    How much to insure a pet or get pet care ?
    The AA allows x call outs per year before you have to pay more
    practices should be able to claim more for multiple attenders

    The genuinely needed frequent attenders are subsidized by the healthy infrequent ones..

    The assumption is that these are inappropriate
    frequent attenders

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  • A tiny charge for plastic bags at supermarkets led to a huge reduction in use of plastic bags. There may be a learning point here.

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  • Be careful with tiny charges. Sometimes it makes the person feel they can use the service more and demand easier access as they have paid.

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  • Participation in training to manage the employers workload is normally paid at usual work rate (plus tea and biscuits). The ‘era of goodwill’ has past.

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  • This article leaves me wanting to know more - what did they do, what did they say to patients, what other services were provided, in the apparently amazing pilot in Bury? But I am mostly cynical - the issues behind this "problem" are often really not for general practice, or even the NHS, to solve - education, housing, social care, employment... It shouldn't be for us to be "training" to deal with all these complex background issues.

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