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GPs go forth

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)

  • What a disgracefulness waste of resources that the Ivans' of this world will never be held accountable for.

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  • Wait till the spin comes out. "more than 50% of pilots show decreased emergency attendance" "This must be provided now to all patients throughout the country". No mentions about the complete waste of resources and the overall waste of resources for little gain. Lies, damned lies and Statistics.

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  • The main objective of the pilots was to put more capacity into primary care not reduce A&E attends. In our area it has supported a lot of really struggling practices.

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  • If NHSE are paying £6 per Pt per YEAR but it costs £5.60 per year, we're looking at 40p per Pt per year profit. We have 15000 patients so that is £6000 profit per year for our practice to open for 1638 extra hours per year i.e. £3.60 per hour profit for our whole practice! I may be missing something but I fear I may not be…..
    Alternatively not looking at profit it is £62.50 total per hour for a practice to provide 8 to 8, pay staff, bills, charges, extra indemnity etc.
    Cannot for the life of me understand why junior Drs aren't storming the doors to get onto GP training programs.

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  • @10.42 But that's the problem. Struggling practices need more money/capacity for 5 day workloads not 7 day access.

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  • erm i think people are missing the point here. yes the service didnt have an impact on emergency admissions or out of hours but it DID result in a 14% reduction in minor illness attendance at A&E departments in 13 of the 20 pilot areas. sorry but that seems to be a big part of why there needs to be extended access in primary care!! Lets not throw the baby out with the bathwater. It works for minor illness so now the capacity is being put in place look at why it didnt work for admissions or out of hours. Maybe if there was not OOH until after the extend PC times it wouldnt be so confusing for patients. maybe if OOH worked more closely with primary care, maybe if primary and community care worked closer together to deal with care home and LTC patients it would start to have an impact.

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  • Anonymous | Sessional/Locum GP24 Nov 2016 10:44am

    stop thinking individual practices and start thinking about collaboratively delivering services across groups of practices to neighbourhoods. Its generally accepted that you cant deliver 8-8, 7 days in EVERY practice but thats not whats being asked for!!

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  • Vinci Ho

    I have started to understand why Pulse has become so 'inflential'. It will be interesting to know how many people from different backgrounds and authorities are 'closely monitoring' this platform every day.
    But as I always said,freedom of speech and freedom from fear.
    All comments are welcome................

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  • Anonymous | NHS Manager24 Nov 2016 11:07am

    It already exists! Its called Out of Hours! Put more money into that instead of duplicating things unnecessarily!

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  • Lindsey Bell | NHS Manager24 Nov 2016 11:04am
    Too many maybes.

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