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Independents' Day

CCGs plan ‘surge’ in GP appointments to deal with reduction in urgent care capacity

Exclusive GPs will take on thousands more appointments a year under a planned ‘surge’ in primary care designed by CCG leaders to take the pressure off struggling urgent care services.

Pulse has learnt that Barking and Dagenham CCG plans for local practices to take on an additional 50,000 appointments a year, as it prepares to close a walk-in centre and reduce attendances at A&E and walk in centres.

The £1m ‘primary care surge’ scheme is designed to reduce duplication of services and treat patients in the most cost-effective location. But local GPs have said they are ‘not enthusiastic’ about the schemes and do not think they will work to reduce A&E attendances.

The scheme comes as Havering CCG becomes the latest area to plan opening GP practices at weekends, joining two areas in the north-west England who also plans to offer routine GP appointments seven days a week, to help ease pressure on A&E services. The scheme will see GP practices opening on Saturdays and Sundays from 9.30am to 5pm.

The scheme comes after health secretary Jeremy Hunt blamed poor primary care provision for rising A&E attendances earlier this year, in a view that was disputed by the RCGP. But CCG leaders do seem to regard expanding GP access as a solution to reducing the pressure on urgent care and saving money in the process.

Barking and Dagenham CCG is closing a local walk in centre and making 25,000 more appointments available in general practice as part of a six month ‘primary care surge’ pilot due to begin in October, aiming for 50,000 extra appointments a year.

A spokesperson for the CCG said it has agreed a one off fee of £1m to fund the first year of the scheme, and it expects to save up to £313k per year as ‘duplication is removed from the system by commissioning services in a more integrated way’.

She added: ‘Practices will shape the scheme to fit the needs of their patients with applications being reviewed currently.’

Havering CCG has agreed a £600k six-month pilot for GP weekend services and is awaiting approval for the business case, which will be decided next week.

It added that in order to be cost neutral, the service will need to reduce A&E attendances that do not result in investigation or significant treatment by 66, or three emergency admissions per week.

Practices will also be asked to hold two appointments per week for patients re-directed from A&E and a care home scheme has been set up that aligns GP practices with care homes to reduce avoidable callouts to A&E.

But Dr Pravin Patel, a member of Barking and Havering LMC, said a previous scheme to reserve GP appointments in the evening for patients redirected from urgent care services had only had three referrals a year.

He said: ‘People are not ending up in casualty because the GP surgery isn’t open, but because it’s convenient for them to go to casualty. Patients are willing to wait four hours in casualty, but they wouldn’t wait four hours in a GP surgery.

‘This new scheme, it looks as if it should work, but I know it won’t. I’m not enthusiastic about it, and none of the other GPs I’ve spoken to are.’

He also has concerns over the funding of the scheme: ‘A lot of the money will go into administration of setting up the scheme. The practitioner consulting will be doing it for very little, for a fee that would be laughable in other professions.’

Dr Natalya Bila, another member of Barking and Havering LMC, said she supported the surge scheme, but wished it was funded for longer than the initial six months.

She said: ‘I am supportive of the surge scheme, the main disadvantage is that it’s short term. It’s similar to what we used to have, but it’s just for a shorter length of time.’

Dr Dan Weaver, joint vice-chairman of Barking and Havering LMC, said GPs would welcome care being provided in general practice if it was fully funded, but that they had ‘reservations’ as if the work was not resourced patient care would be negatively affected.

He said: ‘Any work GPs carry out needs to be resourced. GPs shouldn’t be trying to provide a service they’re not equipped to carry out when there are other services designed to provide it already.’


Readers' comments (12)

  • Disintegrated care is finally here.

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  • Has NICE done a cost/efficacy study on sticking plasters yet?

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  • Why is everyone getting so upset about A&E attendances, which (according to the Kings Fund report) have barely increased in line with population growth when you take out the WICs and Minor Injury Unit?

    When are they going to start getting upset of GP attendances which are genuinely increasing over time?

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  • Just two appointments held back each week for re-directed patients? Cannot be that much of a problem then. The more appointments on offer, the more will be taken up by patients who do not need to be seen. Start getting patients to accept responsibility for their own health and not feeling the need to run and see somebody - be it GP, nurse, WIC, A+E at the first sniffle. At least A+E staff works shifts and can finish when their shift is up - unlike GPs who have tp stay until the work is done (currently 11-13 hours per day).

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  • How about the overworked and overwhelmed GPs?!

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  • services has been trplicated, not duplicated, GP suregry, A/E, and Walk In centre,
    Many pts go there not because they need it, because they are there and can get free precription.
    Charge them a fiver see how many still come

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  • Hilarious how there can be 2 related leading stories in Pulse today :
    1. Pressure on A+E NOT due to deficiencies in GP
    2. GPs to increase appointments to relieve pressure on A+E.

    Is it JUST me ??

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  • Since when have CCGs managed GP contracts? GMS practices have a national contract and CCGs have no powers to impose this
    STAND YOUR GROUND SAY NO. you only have to make arrangements to for those who are ill or believe themselves to be ill. You are entitled to ask for AND RECEIVE such information as you think fit in order to make a suitable triage decision, AND YOU DECIDE WHETHER WHEN AND WHERE a consultation will take place (if at all)

    Peter Holden GPC Negotiator

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  • More work, longer working hours, no increase in pay. This will play into the hands of those who say the A and E crisis is due GPs not working hard enough. Real problem is Drs don't want to work in A and E as it is nearly as thankless a career as General Practice.

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  • Whatever happened to demand management? Are you an accident or do we agree you are an emergency? If not go away you are in the wrong department! Use the services appropriately in future!

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