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The waiting game

Every CCG to get £6 per patient to extend GP access from 2019

All CCGs will be expected to extend GP access on evenings for an extra £6 per patient from April 2019, but weekend opening will 'depend on local demand', NHS England has said.

In the first detailed account of how NHS England will fulfil the Government's mandate of weekend and evening access to general practice, it said total recurrent funding would reach £138m by 2017/18 and £258m by 2018/19.

NHS England explained to Pulse that CCGs would have to commission at least an extra hour and a half of evening appointments, while Saturday and Sunday opening would be flexible depending on local demand.

It comes as the GP Forward View pledged that by 2020/21, over £500m in additional funding annually would enable CCGs to commission 'access to GP services, including sufficient routine appointments at evenings and weekends to meet locally determined demand, alongside effective access to out of hours and urgent care services'.

Today's announcement said 'this will contribute to the overall ambition of investing an extra £2.4bn in general practice services by 2020/21' that was pledged in the GP Forward View.

As previously revealed by Pulse, the funding of £6 per head of population will be made available to GP Access Fund (formerly known as Prime Minister's Challenge Fund) pilot sites during this financial year. NHS England said this would extend to 'a number of additional areas across the country' in 2017/18.

It said the money would also fund an extended access programme covering the whole of London starting this year.

In today's announcement, NHS England said that 'the investment will be extended in 2018/19 to enable the whole country to start developing additional capacity, so that from April 2019 every CCG can expect a minimum additional £6 per head to improve access to general practice'.

The planning guidance document said that it is a 'must do' for CCGs to 'extend and improve access in line with requirements for new national funding' by no later than March 2019.

The document also sets out that by 2018/19, CCGs have to 'ensure' the sustainability of general practice by implementing the GP Forward View - including plans to extend capacity in practices, increasing the number of GPs, co-funding pharmacists to work in general practice, expanding IAPT with more primary care-based theraists, investing in training practice staff, extending online consultations, supporting GP practices to work at scale as MCPs or PACS and 'enable and fund' primary care to 'play its full part' in implementing 'the forthcoming framework for improving health in care homes'.

Dr Arvind Madan, NHS England’s director of primary care, said: 'We know that general practice is under pressure and we are determined to maintain the momentum in turning things around, as started with the launch of the General Practice Forward View.

'Today’s planning guidance, with detail on how investment will look in the coming years, demonstrates the steps we will be taking with CCGs to both stabilise and transform GP services in the years to come, for the benefit of staff and patients.'

GPC deputy chair Dr Richard Vautrey said: 'It appears that NHS England have learnt from the lessons of many of the pilots which showed that there was little demand from patients for routine weekend appointments. There is importantly now no requirement to be open 8-8 on Saturdays and Sundays, with flexibility based on local needs.

'It is sensible that extended hours appointments will also be available for urgent appointments.

But he added that the £6 per patient recurrent funding was 'considerably less' than many of the GP Access Fund pilot areas have received to date.

He said: 'They will now need to cut their cloth according to this reduction in funding. With a shortage of GPs and reduced funding they will also have to consider using other health professionals to provide these appointments.

'In addition we would expect CCGs to work with GPs to integrate current out of hours and urgent care services to avoid duplication and make best use of the available resource.'

Dr Vautrey also welcomed the planning guidance mandating CCGs to ensure the GP Forward View measures are implemented.

He said: 'This is vital at a time when general practice is overwhelmed by unsustainable workload pressures leading to GP burnout and practice closures.'

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Readers' comments (45)

  • The NHSE guidance says the £6 will be commisisoned from hubs not from individual practices.

    In Suffolk (I am from the Suffolk Federation) we had lots of concerns before we started our scheme last year. Could we staff it, would it shift staff from in-hours to OOH (or from OOH to the 7 day service), would patients use it, was it just a glorified ad on for the worried well etc etc. All the same as the concerns expressed on here.

    In reality none of these concerns have been realised. Staffing has neither been an issue or affected practices or OOH, practices are able to book the vast majority of slots so it has relieved pressure on them, patients like it (but Sunday is typically quiet).

    All in all it has worked much better than expected.

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  • Ivan Benett

    Excellent news for users of the NHS, and good for those underpressure with extra demand. Especially good for people who work, for carers who work, and for those with children. Hopefully practices and localities will be imaginative about how they increase access and tie it in with more flexible working and making posts atractive for younger GPs.
    Well done NHS

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  • let some CCG led central hub do this and let them have the rota headaches and the cancelled clinics and realise it cannot be done with the money on offer by the time they pay admin staff/locums etc.

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  • David Pannell - our scheme is similar - we were concerned too - on the whole appropriate urgent patients staffing has been difficult at times but still managed to staff - to expand the service though Im not sure if it would work - we are cheap as bookings are made via own practice

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  • Only works in hubs with practices working together. For GP a Nurse and 2 staff members our staffing costs are just a minimal 1.3 pence per patient per hour. However for £6 a year that is less than 9 hours a week. They expect you to open for 7.5 hours extra per week in the evenings so there is no money left for the weekends! (Not to mention and pay increases for unsociable hours)

    Of course that assumes what they wanted is additional capacity.....Oh.

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  • What is to stop a practice booking all the slots and leaving the other practices short changed? Are the clinics arranged so that there are potential slots for all practices based on practice size?

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  • Suffolk has slots that open at different times of the week (e.g. you can book sunday any time). We monitor how much an individual practice uses the service and can restrict if needed. However, the idea is to support practices particularly if they are under a lot of pressure. We also want to fill all the slots which does not fit with giving each practice a quota. We have had no major issues beyond grumbling around availability on very busy days when everyone wants them.

    None of the issues raised on this discussion board are complicated to resolve.

    For those who still think they want individual practices to open - they don't

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  • Vinci Ho

    Let's be fair and honest about the arguments and evidences so far:
    (1) Any arrangement to increase capacity with more patient appointments outside individual practices will help AS LONG AS it is funded properly by any way. This is the same argument why probably many of us including myself had no problem about the Uber style GP appointments set up by our London colleagues especially in this desperate times and if patients are willing to pay. Though my concern was whether some patients would still have to go back to their own GPs later for certain issues. Of course , these Uber GPs had no access to patients' medical records.If the interpretation of this document is about delivering these additional GP accesses mainly by some local hubs and of course , super or mega-practices , one will presume new IT systems will have to set up in all these hubs to access full or near-full patient's medical record . So there is a set up cost for generalising to cover all areas .
    (2) The Vanguard sites and hence pilots(Cameron/Hunt methodology)were established in high profile with 'good' funding over a fixed period of time and was only extended under the pressure of negative receptions. The original ideology was , if I remember correctly from comments from protagonist(s) , the scheme would ultimately become 'self sufficient' because of saving in secondary care. Then let's look at the evidence recently reported in here:
    ''The researchers said their statistical analysis was ‘significantly stronger’ than earlier studies, and predicted the reduced attendance at A&E amounted to a 27% reduction in costs for treating minor injuries – or £767,976 in 12 months.
    But this was only achieved after the four access programmes in Bury, Heywood, Middleton, and Central Manchester had received combined funding of £3.1 million.
    The paper, published today in PLOS Medicine,states: ‘Health benefits may accrue due to extended access to “out-of-hours” primary care or via better timeliness of care; alternatively, benefits may not accrue should extended access result in substitution of appointments during routine open hours.’
    But it adds: ‘We find the intervention led to a cost reduction in emergency department use of £767,976 the incremental cost is therefore £2.3 million. The intervention would therefore need to see significant health gains to be cost-effective.’''
    (3) So , a logical question, 'Is £6 per head enough and how do you arrive with this figure?' This also leads to questions as far as the design of these pilots are concerned :Should there be arm to arm comparison where the same amount of 'pilot' money was given to locally existing Out of Hours providers or even just to all the local practices to increase capacity ,hence appointments, in just keeping normal hours opening . I am afraid the ethos and telos of conducting a proper pilot study was deliberately obscured by Cameron and Hunt in here , exploiting the passion of those protagonists.
    (4) I concur that this extended access, if funded properly , is to create more job opportunities and clearly , the concern that it would be difficult to get doctors to fill these sessions appeared to be non-existing according to colleagues involved in these schemes. But it also begs the question of simply how much are you paying them for the sessions?Again, if the same amount of money was given to local OOH services in another arm of the pilot study, the conclusion could be different .
    (5) Finally,how 'new' is this £6 per head? If this is another smoke screen for CCG making more cuts from somewhere else , whether in primary or secondary care , the detriment will only come back to general practice on the big picture. The most interesting question remains, as I alluded earlier on , how big is the impact of these 'new' job opportunities created will have on the equation of preventing experienced GPs from leaving and attracting substantial amount of new bloods?

    The truth is the truth and is still out there . It cannot be replaced by 'something like the truth'

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  • so many questions ?

    1. how will extended GP access be managed ?
    2. will individual practices / GPs get any funding and if so how much ?
    3. how will it be staffed ?
    4. is it cost effective ?

    my guess to the answers

    1. upto CCG - it will be a mix of using existing buildings (?ooh) with sharing of staff on a rota and probably forcing some practices to cover with sharing of patient records.
    2. money will probably be pooled and very little will go to GPs directly - suspect rate will be same/less than during normal hours
    3. sharing of staff either voluntarily or forced
    4. if you can get staff to work for next to nothing it will be cost effective

    the plan seems to force all NHS staff to work longer for less and take on more risk. they are going to do this to GPs, JDs and consultants. the rcgp,bma will accept it as they don't want the NHS to go so i don't think we have much choice either accept your fate or leave.

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  • Err, I don't think these things are considered in scientific detail. A strategic goal is set based mainly on the prevailing thoughts in the centre, then policy and fiscal pressure both positive and negative is applied to forge the service in the required mould.

    This is how it has and will always be and it is of no use trying to elevate these things any higher.

    The challenge for the individual clinician or provider, be that a gp practice or otherwise, is to stay and play and make the best of things or bigger off and do something else.

    Medicine changes and the way doctors work changes so how do you seperate the natural evolution of practicing medicine from the policy and fiscal games that attempt to crystallise whatever political objectives held by the rulers of the land.

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