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GPs go forth

GPs set for 35% funding boost as result of CCG's urgent care proposals

GPs may have their funding boosted by up to 35% through providing enhanced minor injury and illness clinics as part of a CCG’s proposals to use its £2m urgent care budget to cut A&E attendance.

The preferred proposal set out by East Leicestershire and Rutland CCG in a consultation document published this week, will involve GPs providing urgent care walk-in centres in core hours, with urgent care services mainly handling out of hours and weekend care.

The CCG said that it is increasing its urgent care budget by around 5% and, if the preferred option of three proposals was chosen, practices that provided the urgent walk-in centres could boost their income by 35%.

GP leaders said that this was something that more CCGs ‘should be doing’, as long as the funding matches the workload.

As part of the consultation process, patients are being asked to give feedback on three options for providing local, urgent care services in an attempt to reduce A&E attendances, with the CCG stating that investment in primary care is the most effective way.

As part of a study, the CCG identified that 48% of the 120,000 attendances to urgent care services are patients presenting at A&E with minor injuries or illnesses when a more appropriate service was available.

These inappropriate A&E attendances cost the CCG as much as four times more than a patient presenting at their GP practice or urgent care centre, £81 per A&E attendance compared with £20 to £47 elsewhere.

The report stated:  ‘At the moment the costs of our minor injury units […] include payment for illness services during the day.’

‘As GP practices are paid to provide the same illness services in the daytime, this means that by continuing to keep minor injury units open in the day we are paying twice for making the same type of service available.’

It noted that patients might be concerned that this will cause longer waiting times due to practices already at capacity with their registered patients. However, it added: ‘All our practices have said that they would be happy to provide this service with patients not having to wait longer than two hours for minor injury treatment.’

Tim Sacks, ELR CCG’s Chief Operating Officer told Pulse: ‘Option three, which is our preferred option, we would expect that we would enhance the [current minor injuries] enhanced service even more, and pay more to practices - 35% more than we’re currently paying.’

‘And this would be so people could walk in – they wouldn’t have to have an appointment – for minor injuries, and we’ve just asked that they would be seen within a two-hour period.

‘Two hours is a damn sight quicker than travelling to an A&E and most practices won’t have some waiting to see people.’

‘We’re going to market this to within an inch of its life, we’re going to leaflet every house, do TV and radio, […] it’s a really simple message and our aim is that over a four-year period we’ll get somewhere around 2.5% reduction [of the 120,000 urgent care attendances] up to a maximum of about 10%.’

Dr Richard Vautrey, GPC deputy chair, told Pulse that this sort of model worked well, particularly for providing urgent care in rural areas where there are significant distances to A&Es.

He said: ‘There has been similar minor injury schemes around the country, I think as long as the price matches the workload then it’s something that practices would look favourably on, and it’s something that CCGs should be doing.’

‘I think the key thing though, is it needs to be long term so practices don’t just stretch services more thinly to be able to cope with the extra workload. They have to enable themselves to invest the money to expand their service, to cope with the workload properly.’

Dr Charles Alessi, a GP and senior advisor with NHS Clinical Commissioners, told Pulse: ‘I am encouraged by the fact CCGs are addressing the needs of urgent care and doing this by engaging with populations in a meaningful way.’

‘Offering people meaningful and transparent ways to engage in a difficult discussion is the way of the future and it is good to see the future is here now in East Leicestershire and Rutland.’

‘Services need to be provided where they are best for populations and within the capacity of services within an area.  Thus there is no best way to manage urgent care which is common everywhere. ‘

Readers' comments (6)

  • Vinci Ho

    This is not something new. Same old problem with minor ailments and injuries. In fact , one can say that was the reason why WIC was created in the first place. Difference only lies in whether nurse led or doctor/GP led. If all WICs have to be 'absorbed ' by GPs , the transfer has to be smooth and transparent ,manpower( appropriate personnels) and resources must be optimal.Do not forget one has to absorb the current workload of a WIC as well as 'encourage' those ,otherwise would go to A/E ,to come.
    It is easy said than done by closing down a WIC and give the job to the nearby practices . The GPs (and nurses , of course) are to see patients who are not registered with their own practices. Perhaps this is where either the old model of GP co-operative or the current fashionable GP federation should come in.
    Funding and planning are key . No one single model will fit all areas........

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  • Our CCG Chief Exec says that in Southampton we couldn't now have a contract for minor injuries, as we have become "de-skilled".

    That is very good news re OOH for us, as we are de-skilled there too, clearly.

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  • The problem is the disproportionate funding between the sectors. Turning to your GP with a urine infection is covered by the £80/year unlimited health buffet. If you turn up to A+E the tariff is still around £80 - enough to pay for a year of primary care.

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  • Peter Swinyard

    Where does continuity of care come in to all this? It really is potentially a charter for those who wish to game the system.
    Would it not be better to encourage practices to look at new ways of managing their workload - like Patient Access, which is working for us - rather than introducing yet another tier of service?

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  • Opening more minor injuries units just increases demand and lowers the threshold to attend. I've attended scratches where the main aim was a free plaster. The same applies to the large number of dental problems ooh at a/e.Worth waiting a few hours to save prescription charges.

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  • Interesting to see how this will be commissioned as technically these services could be delivered by providers other than GPs, wonder how this sits witht he competition and procurement rules...?

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