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Independents' Day

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)

  • I just despair..................

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  • Let common sense prevail

    There seem to be two schools of thought emerging in order to address the issue of 'urgent' access:
    1. Open GP surgeries for longer hours/more days.
    2. Position a primary care facility at the 'front door' of your local hospital - i.e. closely linked to the A/E dept.

    These potential solutions seem to be very different, but each has advantages and disadvantages. Post your opinion here on the preferred model....

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  • Setting themselves up for inevitable failure : "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."

    WHEN will demand be tackled instead of supply ?

    Make everyone do GCSE in self -management of minor illness. Really.

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  • The simplest thing is just to put in charges for A+E minor cases to encourage appropriate use of GP services. Placing GPs in A+E tends to encourage supply induced demand but may be appropriate in some inner city areas. Opening regular practices 8 till 8 will necessitate full shift rotas or contracting in OOH GPs much the same as we have now but less efficiently. I doubt we have the number of doctors or funds to staff it. A third option that needs to be looked at is GP staff grades and non-GP locum doctors covering some of this out of hours work with appropriate supervision from experienced GPs, physicians and A+E consultants (trainees are already allowed to run medical admissions overnight where people are very sick). The bottom line is that out of hours has always been undervalued and therefore under-resourced.

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  • Err isn't most A+E attendance during the day time, when practices are open? It certainly is in our area. Rather than increasing capacity to meet nonsense demand, we really should be changing patient behaviour for the longer term. This is totally unsustainable and also plays into HMG's hands...

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  • I'm sure there will be big sighs of relief at the DOH today as this suggests they have once again achieved a major victory over GP's without a single shot being fired!.

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  • Am I missing something?
    £260k for extending 2hrs each evening in the week and 8-6 weekends - that works out at less than £29/hr per Practice (if split into 6) before tax - to pay reception staff, nursing staff, bills and GPs…….

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  • Why? We don't have the doctors for this. Just creating further rods for our own backs and further down-grading the perception of general practice by providing routine care out-of-hours and at weekends. This is not sustainable and is likely to result in even fewer doctors for the day job (assuming weekend and evening surcharge enough to tempt doctors to do it). Why should the NHS fund convenience appointments when services elsewhere are being cut?

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  • The going locum rate in Manchester is alledgedly currently £450 + superann with demand outstripping supply.

    Weekends would likely cost 20% more.

    If the GP's intend to staff this externally it will cost a fortune.

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  • Who will replace these GPs when they burn out, suffer MIs etc We note people go from here to A+E, will they now have another place to go to after that What happens when the project is over - they will end up doing it as part of "core work" and set a precedent for the rest of us. Madness!

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