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GPs buried under trusts' workload dump

Only 7% of patients who attend extended access GP hubs are over 65, finds report

Older people account for less than 10% of primary care access hub visits compared with 33% of in-hours GP contacts, according to new research. 

An evaluation of the extended hours scheme in East London found that the average age of attendees was 27, compared with 56 for in-hours care. 

However, they said they could not make any observation on the hubs' impact on in-hours care. 

The report, released this month by think tank the Nuffield Trust, compared 3.1 million primary care in-hours contacts with 32,000 hub attendances over a six month period between December 2015 and May 2016.

Under the nationwide scheme - which was implemented in 2014/15 in Havering, Redbridge and Barking and Dagenham to improve access to primary care - seven hubs offering between 1,000 and 1,500 GP appointment slots a week on weekday evenings, Saturdays and Sundays. 

The researchers also analysed patient-level data linking primary and secondary care for all patients registered with a GP in the area since 2013 as well as interviews and surveys of both patients and staff.

Although they could not determine the full impact of the hubs on in-hours GP services attendance, they found that the over 65s made 7% of all contacts.

They said: 'However, the relative scale of these figures suggests that we would be unlikely to observe an impact of the out-of-hours hubs within the in-hours data. We noted above that the age distribution of attendees at hubs and of attendees at in-hours primary care is different, with people aged 65 or over making only 7% of hub appointments compared with 33% of in-hours GP contacts.' 

The report also found that the use of the hubs did relieve some pressure on A&E departments. 

It said: 'Since the hubs opened, there has been an increase in the use of A&E services across the boroughs. However, during our research the size of this increase appeared to be associated with hub attendance in that it was significantly lower in areas where hub attendance was highest by approximately 4.5%.

'This suggests that the presence of the hubs may have been diverting some people who would otherwise choose to attend A&E, or who may have been sent to A&E by NHS 111, away from this service.'

Commenting on the report, County Durham and Darlington LMC vice chair Dr Kamal Sidhu said: 'We have long known now that increased access does not mean reduction in demand.

'At a time when we are thousands short of GPs and nurses, one would argue that we are simply shifting workforce and in fact, overstitching the existing staff.

He continued: 'Hubs are usually sold as increased access to GPs which is not strictly true. There is a long way to go for integration of these hubs with routine general practice. IT tends to be a big let-down. All we end up doing is diluting care in the name of convenience and access. We know that the most cost-effective part of the primary care mode is continuity and seven day access is in clear conflict with continuity.'

In addition, the researchers noted that the impact of hubs on A&E services in rural settings might differ from those in urban locations as they are generally harder to access. 

They said: 'It is not clear how much our findings would translate to non-urban environments. In London, A&E services are generally easier to access, and so the impact of hubs on A&E attendance may be more understandable than in places where the nearest A&E services are more than an hour’s drive or bus journey away.

'Even just within urban settings, the impact would be very dependent on the way the services are organised locally, such as the number, location and opening hours of hubs.'

In a Pulse survey of 650 GPs, 46% said they tried to use overflow hubs when they reached capacity, however when GPs tried to use the service, 53% found hubs to be full.

Health secretary Matt Hancock announced in October last year that extra funding for primary care was ‘mission-critical’ in order to reduce pressure on A&E departments. 

Meanwhile, an evaluation of the GP seven-day access programme revealed that it did not reduce A&E attendances, highlighting that workforce issues challenged the success of the service

Readers' comments (1)

  • It is nice, if a little counter intuitive, to increase accessibility to younger patients. It is important that these young people who objectively have less health issues to deal with are now being given a service that they can interact with.

    All this with no extra investment, and falling numbers of staff.

    Obviously, in no way does it address the failings already present such as inaccessibility for people with health problems, emergency department waiting times etc. Does this new service risk making these problems worse?

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