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GPs plan trials of seven-day opening to combat A&E crisis

Practices in some areas of the north west of England could soon be offering routine appointments seven days a week, under radical plans put forward by GPs to help ease pressure on A&E services.

Under the proposals, some practices in one area would open until 8pm every evening and from 8am to 6pm at weekends. 

Triage nurses in some A&E departments would also be able to directly book patients in for GP evening and weekend appointments.

The plans are from two areas that have submitted bids to a gain a share of a £2million pot offered by NHS England Manchester area team to come up with innovative ways to develop integrated services and shift care out of hospitals into the community.

Teams from Radcliffe, Heywood, Middleton, Bolton, Stockport and central Manchester have been told they have won grants, although they are still waiting to hear which parts of their schemes will be funded for the six-month trial.

In Bury, a GP federation has put in a bid for £260,000 of funding to reshape local services, which would include extending the core hours of six practices in Radcliffe, providing routine and planned urgent appointments from 8am to 8pm on Monday to Friday and 8am to 6pm on Saturday and Sunday.

The federation says that the move will improve primary prevention and reduce emergency demand, reducing the number of people attending A&E departments and walk-in centres with minor ailments by 40% in the first six months and 95% within 12 months.

They also hope to deliver a ‘substantial reduction’ in the use of out-of-hours services by patients with minor ailments, and aim to reduce use to zero by the end of 12 months.

The document says: ‘The success of this project will be measured by a range of indicators including the reduction of A&E attendances and unplanned admissions to hospitals for the residents of Radcliffe.’

It adds: ‘The GP federation is currently working with NHS Bury CCG and the local authority to translate these impacts into measurable KPIs which will be translated into a joint outcomes framework across all providers.’

Michelle Armstrong, chief officer for Bury GP Federation, told Pulse the practices were still working out details of how to cover the extended practice hours, but one option could be bringing in additional salaried GPs.

In Middleton, another group led by Dr Mohammed Jiva has proposed extending opening at nine practices as part of its bid, offering additional appointments from 6.30pm to 9.30pm on Monday to Friday, and a further three sessions of three hours over the weekend.

Dr Jiva, previously credited with pioneering ‘supermarket surgeries’, told Pulse the GPs in these practices would not be expected to work at evenings and weekends. Instead the appointments would be covered by GPs from another provider.

‘We’re tendering out for other providers, like the out-of-hours service, to provide evening and weekend clinics, but with access to the patients’ medical records,’ he explained.

‘From what I’ve done in the past in Sainsbury’s, that’s not new to me – we’ve run clinics in the past with access to four different surgeries’ records at the same time.’

Dr Jiva said the plans would mean offering pre-booked appointments for routine or acute medical problems that need to be dealt with by the practice.

He explained: ‘It’s for things the out-of-hours services and walk-in centres would defer back to the patient’s own GP – we’re providing access in the evening and weekends so that people who have work or family commitments don’t have to take time out during the day to get here.’

Dr Jiva and colleagues have also developed new software, in conjunction with the local acute trust, to create a ‘care diary’ that allows triage nurses in A&E to book up appointments with several different providers, including the evening and weekend GP clinics.

‘Instead of turning the patient away and saying “go and ring your GP”, or “go to the pharmacist”, the triage nurse will be able to hand over an appointment, and from the back office side, each of those providers will be able to see who’s been booked into their slots and at what times,’ he said.

The group hopes both approaches will help alleviate pressure on overstretched A&E services.

Dr Jiva said: ‘There’s two things – one is people who are not addressing minor ailments are eventually becoming more severely ill and needing to go to A&E. Giving them access to a larger part of the day for routine care should mean hopefully they’ll address issues when they’re minor and not requiring A&E attendance.

‘The second thing is about re-educating the public, so they know that A&E is not their first port of call – and now their local services are going to be available until half-nine, ten in the evening so they don’t have to go up to A&E.’

The extended opening plans as NHS England begins a major public consultation on the future of general practice, with improving access to routine GP appointments at the top of its agenda.

Readers' comments (38)

  • There have been a number of reports suggesting that there has been little increase in A&E activity so can someone explain how the crisis has arisen and why it's general practitices responsibility to sort it out?

    I thinnk that the ideal of practices opening longer is a good one if properly funded but as the last post points out, the figure just dont stack up. I can only imagine that someones put a decimal point in the wrong place!

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  • Peter Swinyard

    Curiously incomplete idea. GPs are part of a team. We need our practice nurses, reception staff, HCAs etc to work fully and effectively. We also need hospital teams to be there on the end of a phone for routine tests/enquiries/chasing up appointments etc etc etc - all part of the working day. And did no-one consider the essential nature of continuity of care??? We must try to put a halt to this 24/7 mentality which is led by want and not need. I do not need to see my GP to discuss my piles at 7.30pm on a Sunday - it can wait. My solicitor and accountant are not open then, why should we be?
    Yes, we need good services for all unscheduled care but:
    [1] there are not enough GPs to cover today's service needs and not enough in training to fill the gaps as all us old chaps race for the exit
    [2] politicians lack the will to say NO to anyone
    [3] rather bonkers idea of having a contract force of GPs coming into surgeries to get access to records. What about the N3 connections???
    [4] the doctor-patient relationship is more than the customer-Tesco cashier relationship.
    [5] without demand control, the NHS will go bankrupt
    [6] be honest with patients. If "their doctor" is working on a Saturday and Sunday, he/she will NOT be there on Monday and Tuesday.
    [7] imagine trying to get your practice manager to arrange a partnership meeting as three part time and two full time partners work 7 day shifts.

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  • Unclear how this will reduce A&E attendances since little evidence from previous schemes of any significant impact: the facility for triage nurses to book directly into GP appointments will surely INCREASE A&E attendances, with those unable to get an immediate apointment just pitchng up to A& to have someone else book it for them: yet another example of how some of our colleagues will scramble for quick money rather than consider the full consequences of their actions

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  • already given up hope NI GP

    General practice abhores a vacuum.I firmly believe if we opened our surgery from 2am-5am after several weeks we would have full surgeries.Manage needs not wants.Expand UNSCHEDULED care and most important of all learn to tell patients when there attendance is inappropriate.

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  • One issue is that as much as A+E departments bleat on about being busy they do quite nicely financially out of inappropriate attendances (they're fairly quick and pay well), including those of their own creation (our local hospital insists all admissions go via A+E- so they get an I/P tariff and an A+E tariff). We live in a consumer society where patients are used to video-on-demand, 24/7 access to e-mails via their ipad etc, they expect a level of service incompatible with the level of funding provided to general practice. We shouldn't have to put UCCs in A+E departments to get patients who don't need to be there to go to their GP- a good old fashioned telling off and a refusal of service would suffice. But it's not in the interest of the department to do that- takes time and doesn't pay.... When people have unrealistic expectations you can either pander to their expectations or disabuse them of them..... Of course a government department will rarely tell people to wake up and smell the coffee (not a vote winner)... GP practices being open 7/7 combined with named doctors being available 24/7 to discuss cases is a recipe for a huge increase in locum / salaried GPs with partners being on-call all the time but rarely seeing patients. Queue the end of continuity of care- you may as well send everyone to the UCC and close the practice! Sigh....

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  • i think this is excellent idea. i hope money is sufficient to deliver services and surgeries need to within easy reach of locality, otherwise it will be not very successful.
    good luck .

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  • Absurd idea. Why don't they just get on with it and privatize the NHS?

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  • Most of the comments seem to be along the lines of "Why are we not going to be paid a reasonable amount for providing this service". The only one (there may be others) which makes sense is the idea of teaching self care. Call me old-fashioned but we used to be taught basic first-aid as part of our schooling.
    Providing GP appointments via A&E will make patients who cannot get through to their GP attend A&E to get an appointment with their GP!
    It appears the majority of people have lost the knowledge taught by their parents/grandparents about how to treat certain -mostly self-limiting - conditions (e.g. sunburn) and instead trot off to their local hospital.

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  • Can't all of us see where it is leading to. COLLAPSE OF GENERAL PRACTICE & NHS. Politicians very well know that current system is unaffordable, but we are still trying our best to make it work. So what does government do? It makes it more difficult for us. Ultimately we will not be cope with rising demand & cost & finally we will give up. Then government can blame it on GPs saying look it is GPs who have left NHS. We better start telling our patient that it is last few years before they have to pay to see G. ( I have already started doing that)

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  • Didn't realize Darzi centre was so successful.

    I seem to have forgotten why there are closing. Could someone remind me again?

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