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Independents' Day

Seven-day GP opening had 'no impact' on emergency admissions or out of hours

Extending access to routine general practice across seven days had ‘no demonstrable impact’ on either emergency admissions or out-of-hours services, NHS England’s final evaluation of the first £50m wave of pilots has concluded.

Minor illness attendance at A&E departments reduced in 13 of the 20 pilot areas analysed by 14% on average, saving a total £1.9m, said the report.

Of the £60m spent on pilots up until September 2015 (which included central funding and CCG additions), £18m were spent on extended hours, £25m on ‘other enhanced primary care initiatives’ and £17m on infrastructure such as IT and project management.

The average cost per total additional extended hour was around £215, while the average cost per available appointment ‘was typically around £34’.

The analysis, which comes as NHS England has already allocated £6 per patient for all CCGs to roll out GP appointments in evenings and weekends from April 2019, calculated that ‘the annual cost per registered patient to support additional extended hours is £5.60’.

A Pulse analysis revealed last month that at least £1.5bn will be ploughed into extending GP access by 2021, but the Conservatives will still not be able to deliver 8-8, seven day access to all patients by 2021 in line with their manifesto.

But the report reiterated the advice from the interim evaluation, concluding that ‘given reported lower utilisation on Sundays in most locations, additional hours are most likely to be well utilised if provided during the week or on Saturdays (particularly Saturday mornings)’.

It also said feedback suggested weekend appointment ‘might best be reserved for urgent care rather than pre-bookable slots’.

The report said: ‘As detailed above, 13 of the pilot schemes have collectively seen a reduction in minor attendances at A&E from the date they went live with initiatives up to November 2015, the total reduction of which was 44,400.

‘This would generate a reduction in annual expenditure for commissioners in this service of £1.9 million. This saving would need to be offset against the investment in primary care.

‘For emergency admissions and out-of-hours services, there has been no demonstrable impact and, as such, there are unlikely to be any cost savings.’

But the analysis found promising results for the ‘hub and spoke model’ by groups of federated practices. It said the pilots showed this did ‘enable practices to deliver a wider range of services to patients over more hours of the week’.

It also said the Challenge Fund, later renamed the GP Access Fund, ‘provided a much welcomed injection of investment into the primary care sector’.

An NHS England spokesperson told Pulse: 'The key objective of the GP Access Fund was to strengthen GP services and provide better access for patients. But they have also shown real potential to reduce the pressure on other parts of the NHS, including a 14% reduction in lower acuity cases in A&E.'

NHS England has said it will publish the evaluation of the second wave of pilots later this year.

The report also found:

  • ‘On average, the annual cost per registered patient to support additional extended hours is £5.60. This represents a full cost covering all clinical staff time and overheads associated with setting up a new service; typically 50% of this cost can be attributed to GP time. The annual cost per hub serving 40,000 registered patients is therefore around £224,000.’
  • ‘IT interoperability, information governance, securing indemnity insurance procurement and CQC registration have been the most commonly cited process barriers.’ These ‘challenges’ have ‘caused mobilisation delays and had cost implications’, with NHS England having tried to intervene to help Wave 2 pilots not face the same problems, said the report.
  • ‘Capacity issues’ included ’difficulties in recruiting (especially ANPs) or competing with OOH providers for GP time’. The report said ’some pilots have relied on incentivising GPs… and this may not be sustainable in the long term’.
  • ‘Telephone-based GP consultation models have proved most popular and successful’ out of alternative extensions to access piloted. But ‘other non-traditional modes of contact (for example video or e-consultations) have had fewer tangible benefits with issues around implementation’ (including low take up).

Source: Prime Minister's Challenge Fund: Improving Access to General Practice, second evaluation report to September 2015, by SQW and Mott MacDonald


Readers' comments (25)

  • I just want to ask how much money Mr Hunt has wasted and still is going to?

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  • Extended access is not Out of House because practices cannot book patients directly in and in our patch OOH don't have access to patient notes. Again in our area there is not much spare GP capacity in-hours but GPs and NPs are more than willing to work weekends/evenings

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  • A waste of money.
    Why do they never consultant with coal face practitioners?
    Oh forgot, sometimes they do, and then ignore them!

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  • I wonder how much it has cost us to find out that indeed bears do defecate in woods.
    More worryingly is that the govement is ploughing ahead using £6 per head of general practice money to keep these schemes going longterm, despite the evidence that it is purely about ideology and makes not one jot to capacity and quality of care.

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  • The only relevant study would be to randomly give the same £/patient to practices directly to improve their own access (appointment numbers not opening hours) for comparison.
    Why no one looks at the marginal cost of GP appointments in their own practice rather than setting up schemes that are twice as expensive is beyond me.
    The problem is one of capacity not peaks and troughs of demand given we are permanently at peak!

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  • Practices do get funding for additional appointments if they want to take it up = Extended Hours.

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  • Lindsey Bell | NHS Manager24 Nov 2016 11:04am

    Couple of questions not clear on this exercise;
    1. Was the reduction due to necessary attendances being seen at the right place or was it unnecessary (i.e. want rather then need) attendances taken out of inappropriate place? Former is great, latter will be better managed by managing demand and promoting self care.
    2. Is the reduction sustainable? Many trials on front door triaging and behavioural modifications in AED has shown trend reverts back to normal after 6-12 months. This is backed by steady and regular increase in AED attendances over the last decade despite many attempts and models to curve the attendances. I suspect project like this will show a short term change but no long term improvement (and we'll be left with increased demand which we've created).

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  • Anonymous | Work for health provider24 Nov 2016 12:34pm
    If they funded it properly then practices would be able to book directly into OOH.
    If they funded it properly, then OOH bases would not have to close then there would be capacity.

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  • Lindsey Bell I think you are missing the point.
    It cost at best £18 million, at wrost £60 million, to see and treat £1.9 million worth of minor illness.
    I would much rather see that money invested in A&E doctors and nurses who let's not forget aren't having a great time either.
    Might be worth checking the article a little more closely next time prior to accusing people of missing the point.

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  • Point of trials was not to save money, or improve outcomes. It was to forward a toxic political agenda. The results are not important to them. Just the rhetoric

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