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PM's seven-day access pilots to be extended as NHS England claims 15% reduction in A&E attendance

Exclusive NHS England will extend funding for its national seven-day GP access pilots to allow ‘fuller analysis’, after admitting that there was insufficient data to measure the success of the scheme ten months into the year-long pilots.

It said it needed more time to gather the evidence to be able to ‘demonstrate success’, adding that early feedback was ‘very good’, including some areas claiming to have achieved a percentage reduction in A&E attendances in the double digits.

NHS England also revealed that there was not as much demand for Sunday access as there was for weekday evening and Saturday appointments.

But the GPC said that pilots were not necessary to demonstrate a lack of demand for Sunday opening, adding that pilots were unable to get off the ground due to a lack of GPs.

The pilots for the ‘Challenge Fund’ - which was a £50m scheme set up in late 2013 by the Prime Minister principally to move towards seven-day opening - were due to begin in April 2014 with funding available for a year, after which CCGs would continue funding the schemes.

The Prime Minister followed this with an announcement in October 2014 that £100m will be provided for a second wave of schemes.

But Pulse revealed last year that most of the original pilots had yet to start last September.

NHS England is now saying that there is insufficient data to judge whether the schemes have been a success so far, and it will increase the funding for the intial wave of pilots.

An NHS England spokesperson said: ‘The pilots have only been operating for a short period of time and we need longer to get the evidence needed to demonstrate success. However, early feedback from patients, clinicians and managers has been very good…’

‘To achieve further benefit, pilots will continue beyond March 2015 for up to six months and will receive additional NHS England funding to enable further evidence to be gathered. By extending the pilots this will enable a fuller evaluation of the schemes. Together with local CCGs we will work with pilots to identify how the most successful aspects can be taken forward.’

They added: ‘In general pilots are finding demand is greater on weekday evenings and Saturdays, with less demand for Sunday appointments. They are continuing to adapt their offer to meet local patient needs.’

They also said that early feedback on reducing A&E attendances was ‘encouraging’. They added: ‘At present, it seems likely that reductions in the region of 10-15% or more may be achieved by improving access to primary care.’

Although full analysis will be available in the summer, NHS England told Pulse that:

  • The Arden, Herefordshire and Worcestershire pilot data indicated A&E attendances reduced by ‘more than 10%’ (three extended access hubs run under the pilot, with the first opened in July and the last in September).
  • The North West London, the pilot in one CCG area reported a 10% reduction in daily A&E attendances and a 7% reduction among the over 65s in hospital admissions (offers Satuday and Sunday services).
  • A participating practice in Birmingham reported a 25% drop in A&E attendances among its patients in November 2014 compared with November 2013.
  • A pilot in South Kent supplying paramedic and GP home visits saw 33% of A&E attendances avoided.
  • In Whitby, north Yorkshire, 80% of weekday evening appointments were booked up.
  • In Hertfordshire and South Midlands 74% of the 7,000 additional appointments were used.
  • In Morecambe, call volumes to the extended access service was at 286 but this had grown to 900 by last month.

But GPC chair Dr Chaand Nagpaul said: ‘It comes as no surprise that there in insufficient evidence of benefit from the 7 day pilots, and we must not repeat the failed experiment of the 7 day Darzi walk in clinics, many which have been decommissioned due to low demand. Neither did it need these pilots to know that there is inadequate demand to see a GP routinely on a Sunday.

‘Several challenge fund sites have yet to get off the ground due to a lack of GPs able to work extra hours, and in many there is no evidence of any reduction in A&E attendances. We must also account for the hundreds of millions of pounds spent on running these pilots in any analysis, rather than looking simply at crude A&E attendance rates.

‘At a time when general practice is struggling with unmanageable workload, a lack of capacity and too few GPs, the priority must be for precious NHS resources to be used to support GPs to meet the needs of patients that need us the most, especially the vulnerable, frail and those with greatest morbidity.’

NHS England’s announcement comes as the scheme has already been awarded an extra £100 million to run a second wave. The successful bidders will be announced in the spring, when NHS England will also reveal how much extra it is spending on the wave one sites.

NHS England had said CCGs will decide what from the pilots they will want to continue to commission after the Challenge Fund investment had run out, because ‘it is obviously in commissioners’ interest to ensure they are investing in the most appropriate services for local people’.

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Readers' comments (28)

  • Does anybody expect anything other than a significant amount of spin.

    Hugely successful after operating for a few weeks?

    I also remember my local minor injuries unit being hugely successful at reducing A+E attendances initially - only to eventually level off at providing no actual benefit - it is now closed.

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  • I feel 7 day access is possible but would need a exponential increase in GP numbers and a lot of additional resources to support it

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  • So, well done to our GPs who work weekends

    I won't be!!

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  • Vinci Ho

    you see
    like many medical sinario,the figure 10-15% is so often popping up(read the other article about statin) and represents a starting point for debates.
    Once again, you need a honest debate with proper amount of evidences.
    Bear in mind ,number of working GPs is also a piece of evidence.

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  • Lies, damned lies and statistics, to quote Disraeli.

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  • our CCG cited their local enhanced service to avoid admissions as the reason for 7% less admissions to A&E (year on year apparently)

    we were surprised, and asked for the numbers.

    6 months on, still waiting.

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  • Where's Ivan?

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  • So, more appts available in evenings and weekends, and 74% or 805 were fully booked up? Of course, because people will continue to book them if they are offered! Strewth this is banal stupidity!
    Were the attendances genuine need of GP care, or just easy access for minor illness that would have gone to A&E?! Cheap GP consultations compared to A&E is all well and good, but the population needs educating on self-management and using Pharmacies etc.
    Stats are great, but they can answer any question posed, without addressing the real issues!

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  • As always NHS England talks to figures and data, instead of talking to front line doctors. Minor injury units, the most luxurious service for a system in a negative equity.- a provider induced demand.
    How the fundamental point is never brought up, change in public mentality of " go to the doctor", self care and personal responsibility.

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  • More money is spent in analysis, management consultancy, pilots, then spending money on providing services.

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  • W e have large swathes of society that demand instant gratification of their non emergency health needs (there may be many reasons for this) ,and they will always make use of a&e departments. If these "customers" (that is what they have become) are prepared to travel to a&e departments and wait, rather than make a routine GP appointment in office hours, doesn't it make more financial sense to staff a&e departments to cope with this demand, rather than fund every practice in the country to stay open. all hours.

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  • so if there was 24 hr 7 day a week service there could be a 30% reduction ?

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  • Offer people a service based around increased convenience (rather than clinical need) which they don't have to pay for and then act amazed that it's "popular" with the users. Maybe the pilot should offer "extended hours" co-pay slots based on typical rates for getting a plumber or a lawyer in the evening or at a weekend - see if it's still as popular?

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  • Azeem Majeed

    I undertook one four-hour Saturday morning shift in a seven-day access pilot in Clapham, London. It was not particularly busy - I saw about 3-4 patients per hour in my 4 hour shift (if only normal surgeries were like that). None of the patients I saw were very unwell and it's unlikely any of them would have gone to A & E if the extended access service has been unavailable. I'll be interested to see the results of an evaluation and if there was any impact on attendances at the local A & E units.

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  • Why the silence Ivan?

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  • I am sure it would decrease A&E attendances when people get into the know about it, but that is not the point. THERE ARE NOT ENOUGH G.P.S TO DO THE JOB + ALL THE WEEK DAY WORK AND IF THEY TRY EVERYBODY WILL BURN OUT.

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  • Ivan Benett

    Anonymous | GP Partner | 17 February 2015 5:37pm
    Where's Ivan?

    Anonymous | GP Partner | 18 February 2015 10:15am
    Why the silence Ivan?

    Guys, I'm flattered, but come on, I've been seeing patients!

    7 day working is here to stay, so why not just get used to it. YOU don't have to work at weekends, but it suits some doctors who want a more flexible lifestyle.

    More importantly it suits many patients, especially those who work, those with child care commitments and other commitments.

    It will allow us also to manage more in Primary care like planned care stuff - out patient clinics and diagnostic. Also we'll see patients at an earlier stage of decline so we can intervene to stop them needing an adimission.

    In our modest pilot, which has received perhaps more publicity than it warrented, we have had about a 10-15% reduction in A&E attendances during the hours of the extended hours. We also have a consistent finding of a 50% in people turning up to A&E saying they can't get an appointment with a GP. Finally, about 20% of those attending extended hours say they would have gone to A&E if the service wasn't available.

    Look, it's not perfect, but it offers patients a wider choice of hours to attend, and it helps manage both planned and urgent care a little. BUT it must be seen in the context of the need for much wider reforms AND investment in GP workforce, estates and IT.

    PS Don't hide behind anonymity.....oh, and come up with a better solution. Who knows you may be right!

    In-hours access is really important, but so is access for people who can't easily make those times....after all they do pay for a service from their taxes...

    Anyway, can't stop. Meeting pals on the golf course soon.

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  • When our practice adopted telephone triage for same day access 2.5 years ago, the resulting drop in A/E attendance was dramatic and far greater than any of these massaged figures. But does that mean we extend this model and continue telephone triage all night and at weekends? That would be ridiculous.

    Dear Ivan - the so called taxes the GBP are paying doesn't even cover their in hours care, let alone extended hours. Why do you think capitalist health care systems do not adopt the 12/7 working pattern? Because it is not cost effective to do so. The tax payer (and let's face it, there are not many of us left) are paying for the indulgence of some people to visit their doctor on a Sunday because little Violet has extra-curricular activities every day after school.

    Continuity of care is the key to effective long term condition management and elderly care. You are not going to get that with a bunch of shift workers clocking on and off like a locum.

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  • Ivan Benett

    Nabi - Hi again. It's been so long. Not sure about your logic there, but let that pass. I'm not sure what you mean by 'capitalist health care systems' either.
    I do agree about continuity of care being the key to LTCs/end of life/ mental health and many other issues. Making it hard for (hard) working people to attend isn't going to make continutiy of care easier. You're more likely to get better continuity of care if you have a greater flexibility of times when you can access a doctor who has access to your notes, and preferably your doctor. I really see access and continuity as separate issues, and we need both..I'm pretty sure you're not there all the time, just in case your patients want to see you. The profession gave up on continutiy when we all agreed to opt out of 24/7 responsibility. This is a separate arguement from extended access.
    And it's not so much little violet that can't make normal hours, school ends early afternoon, it's her mother or father who is working.

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  • Ivan Benett

    PS I'm not really on the golf course, I'm still working

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  • Congrats Ivan - looks like you were right !

    what are your thoughts on opening 24 hrs 7 days a week. we could work in flexible shifts and reduce costs on OOH, walk in centres ?

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  • Ivan, please call me Shaba. After all, we must be on first name terms by now.

    By capitalist health care systems, I mean countries like USA don't even operate 12/7 hours. And that is because it would push up the insurance premiums to a point where no - one would be willing to pay.

    You are living in Laa Laa land if you think you do not lose continuity at the expense of access.

    As for little Violet ' s parents- they still manage to attend a solicitor when they want to get divorced or their bank manager when they need to split the house - all in working hours.

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  • i have a chuckle every time Ivan talks about 7 day access because The Range Medical Centre is closed for appointments on Weds afternoons! I hope poor Violet doesn't get a bit conjunctivitisy on Weds lunchtimes

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  • The Government talks as if the only priority is relieving pressure on A & E departments. What about the pressures on general practice, particularly as we are facing yet another recruitment crisis?

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  • You can make statistics say exactly what you want them to say!

    My GP opens late one evening per week, reception staff paid to cover this time, GP's available …. so where are all the patients so desperate fro appointments?

    Probaly sitting in A&E with a splinter in their thumb!

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  • I work in general practice.
    I used to work in A&E (7 years).
    In my experience the patients who rocked up to A&E saying they couldn't get an appointment were most likely to turn up in the morning, monday to friday.

    This, although anecdotal, would be as one would expect.
    People who discover they can't get an appointment usually find out in the morning.

    Undoubtably the next busiest time for patients who should have seen their gp was saturday morning.

    I don't know why 'the research' differs from this.

    The other observation I would like to make is there doesn't seem to be any spare appointments in anyones day.

    I would speculate that if there are no extra slots for evening and weekends access is not improved.

    Depending on your definition of access.

    If a slot appears in the evening then there will be one less slot in the day.

    Bearing in mind my observation that the majority of 'can't get an appointment ' patients rock up in the A&E in the morning I would speculate that the number of those patients may increase.

    I would be interested in any expert opinion to why this would not be the case.

    Thanks for reading...

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  • in addition to my last comment 7:38

    Nobody, sensible, chooses A&E over general practice.
    In A&E you wait hours and see a very junior doctor.

    The daytime access to our GP's needs to improve.

    Unfortunately, using my definition of increased access -more appointment slots, this is not easy and is expensive. It requires more GPs...a lot more.

    I would argue that you only know you have enough slots (so that none of your patients have a good excuse to go to A&E) if you have at least one empty slot at the end of each surgery.

    I don't know of anyone that has these empty slots.

    Until this is solved in the daytime, I can't think why we would start trying to improve out of hours access.

    Again I would happily hear from anyone who disagrees with my thoughts. They are based on only my own experience.

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  • Complaining and sniveling either deserves no response (i.e. if you
    don’t want to eat Mexican food, don’t come, you won’t be missed)
    or a strong response, designating them what they are: malingerers
    seeking compensation for no value delivered. Or, in even plainer
    English, thieves.

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