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Independents' Day

GPs to offer half-hour appointments as paramedics take on home visits

Exclusive GPs will be able to offer extended appointments that could last up to half an hour, after a group of local GP federations received £42m in funding from the GP Forward View.

According to GP leaders in Manchester, the funding injection has allowed general practice in the city to 'breathe' by paying for extended appointments and a wider clinical workforce in practices.

This includes hiring paramedics to take on nearly all home visits in the city, freeing up time for GPs to spend on patients with complex needs.

Dr Tracey Vell, chief executive of Manchester LMC, told Pulse that the extra funding ‘will make every GP have the capability to go to 20-30 minutes of quality, continuity-of-care appointments’.

Dr Vell added that with the extra time, GPs are able to spend longer with patients with complex needs, which she said is where continuity of care ‘really kicks in’. 

She said: ‘Continuity is less important for some populations, but what we are doing is giving patients that choice, we are not making it for them.

‘We are saying you can see your GP on this day, but if you don’t mind seeing any GP in a different setting on the same day, you could choose that.’

She added that the extended appointments scheme is 'assisted by the time we save in not doing home visits, or not every home visit'.

Dr Vell said that some of the £42m was allocated for 'additional workforce', adding that some practices have access to 'paramedics that are starting to do home visits for GPs', while a clinical pharmacist is now stationed in every GP ‘hub’.

GPs in Manchester operate in hubs of up to six practices, covering between 30,000 and 50,000 patients each.

The hubs are divided into ‘local care organisations’ (LCOs), with between five and six hubs in each of 10 LCOs across Manchester.

One LCO went out to tender earlier this year for a 10-year contract worth £6bn to deliver all non-acute healthcare except core GMS contractual services to 600,000 patients.

This comes as Dr Robert Varnam, NHS England’s head of general practice development, told delegates at the RCGP’s Annual Conference that GPs have 'chosen' to work in 10-minute appointment slots, which he said is 'unethical'.

Meanwhile, a review backed by the Chief Medical Officer found that a current average 9.2-minute GP appointment ‘does not give sufficient time' to discuss treatment options.

Healthcare devolution in the 'Northern Powerhouse'

Former Chancellor George Osborne announced two years ago that the NHS in Manchester  would become devolved from central Government, as part of the Government's 'Northern Powerhouse' plans.

The deal saw the local authorities, alongside CCGs, given the freedom to jointly commission health and care as they pleased in the local economy.

Since then, in an even more far-reaching shake up, NHS England has unveiled plans to devolve responsibility for commissioning to care organisations themselves.

This will see, in the long run, all of a current 44 Sustainability and Transformation Plan (STP) areas become 'accountable care systems' in future.

NHS England has named Greater Manchester as one of nine 'likely candidates' to become one of the first such ACSs.

In return for becoming an ACS, NHS England has promised the organisations ‘more control and freedom’ over their regional NHS including receiving devolved national GP Forward View, mental health and cancer funding from 2018.

Readers' comments (27)

  • every patient does not need 30 minutes. if pt want to renew sick note, what are we going to do with him for 28 minutes?? 10 minutes are not enough for elderly or acutely ill patients.
    home visits mostly are not required. nursing home and care homes need some different arrangement then relying on small practices to visit patients morning, afternoon and evening.

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  • "This includes hiring paramedics to take on nearly all home visits in the city, freeing up time for GPs to spend on patients with complex needs."

    I believe the word for this is oxymoron.

    Scrap home visits. The rest of the world copes without them.

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  • Shaba, the rest of the world may not be right!
    What do you suggest for end of life care at home?

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  • 1:56 'scrap home visits' Shaba? Sounds attractive, and we might love to do that, but who will care for all these people?

    in this coastal town my practice does 70-100 home visits PER WEEK for elderly frail housebound/care home residents. Many of them are very unwell, most have end of life care out of hospital. We have a GP and a paramedic visiting all day every day
    My practice has one of the highest prevalences of dementia in Europe, 250 patients aged over 90, and 400+ severely frail
    Are you suggesting we 'do a Babylon' like some of our local practices do (especially the PMS ones) and just refuse to take these people on, or deregister them leaving NHS 111 and the ambulance service to manage?

    This pattern of work will be familiar to many GPs in coastal towns. How come Manchester is getting all the cash again?

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  • Mad as a hatter or as Manchester. Why Manchester again,,,,,let's guess!

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  • If the use of paramedics frees up gp time why is £42m needed?

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  • Scottish GP and Copernicus

    I don't think Shaba is suggesting that GPs never do home visits. We agree that is part of the ongoing care for housebound patients.

    As you all know the problem is we never get the chance to do any proactive long term care because what little time we do have between surgeries is taken up with responding to 'acute' illnesses and concerns such dizziness , falls , nausea, weak legs etc etc... the list could go on indefinitely.

    Believe it or not the rest of the world also has end-of-life scenarios and patients with dementia. Other countries with better health outcomes than the UK seem to manage without GPs frantically trying to squeeze home visits between the morning and afternoon session.

    Perhaps if the acute requests for home visits (which use up most of our visiting capacity) were passed on to paramedics or a dedicated service GPs would be free to go on home visits to manage the long term conditions of the patient groups you mentioned.

    Shaba is not wrong here. Home visits for urgent care needs should not be part of the GP contract.

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  • Replacing one big waste of time with another one if you ask me. Home visits by GPs are a thing of the Dr Finlay days. paramedics can deal with acute visits, ANPs/palliative care nurses can deal with end of life care, and pharmacists can do planned med reviews for housebound/care home residents. However I don't feel that using the freed up time for 30 min appts would be any good. In my practice we have a "duty doctor" on the busiest days of the week. They don't visit, but can get through at least 10 telephone consults in the same amount of time.

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  • Shaba as usual is dead right.

    Home visits are in most cases a colossal waste of time. I worked in Australia in 1994 and didn't do a single visit then. Here I do hundreds. It's a relic of a dinosaur age.
    There is far too much to do in normal time and I try my best to get out of as many possible.
    Snowflakes/millenials/cardies/RCGP types say what you want.
    I hate visits.

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  • NHS England’s head of general practice development, told delegates at the RCGP’s Annual Conference that GPs have 'chosen' to work in 10-minute appointment slots, which he said is 'unethical'.
    I presume the good doctor has a duty to report this unethical behaviour to the GMC?

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