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NHS managers 'exploring' GPC plans for 15-minute appointments

NHS England has expressed support for GPC plans for practices to be able to refer patients to an 'overflow' hub to give them time to offer 15-minute appointments.

Under the plans, CCGs would commission a separate medical centre - labelled a 'hub' - staffed by GPs and other health professionals that would deal with urgent on-the-day problems such as infections and minor illness on behalf of a group of GP practices. 

The GPC says having these 'overflow' hubs would enable GP practices to offer 15-minute consultations to patients who need them, and cap patient consultations to 25 a day to reduce workload.

A spokesperson told Pulse that they were 'exploring the idea', while head of general practice development Dr Robert Varnam told Pulse this idea - presented by the GPC as part of its Urgent Prescription for General Practice - 'does really work'.

The spokesperson said: ‘We are exploring the idea of overflow hubs with the GPC as part of ongoing discussions aimed at further supporting practices and improving services for patients.’

Dr Varnam said GPs had talked of such plans for a long time, but that the GP Access Fund pilot programme (formerly Prime Minister's Challenge Fund) had now proved that 'by and large it does really work'.

But, he added: 'Practices themselves have to agree they are going to do that. No one could force them to do it.’

The GPC has highlighted areas that have made it work including Lambeth and Southwark in south London, Gosport and the New Forest in Hampshire, and in Oxfordshire.

Elaborating on the idea last month, the GPC said: ‘The immediate introduction of 15-minute appointments would allow improved decision making and case management, and should reduce the administrative burden outside clinic times by facilitating more activity within the appointment.

‘As patients increasingly present with more complex conditions, longer consultation times are necessary to ensure safe and high-quality patient care.’

NHS England's support of the plans come as GPC last month called off plans to ballot GPs on mass resignations after claiming it had won concessions on workload from NHS England.

According to the GPC, this included NHS England agreeing to discuss the rollout of plans proposed in the GPC Urgent Prescription. 

GPC chair Dr Chaand Nagpaul told Pulse these overflow hubs were 'no panacea', but said: ‘We do need some radical solution to limit workloads. Given that NHS England has earmarked significant funds for transformation, we believe this would be an appropriate call upon that resource.

'It links in with the GP Forward View’s own comments on resourcing locality hubs.’

But some GPs were critical of plans. Dr Shaba Nabi, a GP in Bristol and a board director of Avon LMC, said 'there aren’t enough people to staff it'.

She added: 'What you are doing in fact is reducing continuity of care, a crucial element of urgent care. You can’t separate long-term care from urgent care.'

Read all about the GPC's plans here

Readers' comments (31)

  • Neil Bhatia

    Shaba is right. Where are the staff for these "hubs" going to come from - GPs and nurses working their days off? Are we going to divert clinicians from working in out-of-hours to working in these "hubs" instead?

    Continuity of care is vital if we are to successfully manage patients (and keep them out of hospital), this will fragment it.

    You need more funding for GP practices, and make GP an attractive career, so that practices can hopefully recruit more clinical staff, and *then* think about increasing appointment times.

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  • Pie in the sky thinking with a service in free fall just what we need, NOT!

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  • I agree that you cannot separate acute from chronic illness. Doing this will increase risk for the patient and also create more wasting of clinician time- both for the GP to read the inevitable letter generated and also for the acute clinician who will have to read ( if they have access) all the patients previous notes.
    This sounds like a solution written by someone who has no knowledge of general practice.
    Medicine has progressed exponentially over the last few decades.You only need to see the expansion of the BNF.Patient expectation also- old people no longer expect to get infirm or to die, apparently.In order to provide a health service to cater for this demand we need many more doctors and nurses.
    General pracitce cannot be allowed to continue as it is, it is damaging doctors health and is too risky for the patients.The answer is to increase the numbers of doctors and nurses. If the government cannot afford this , then they have to limit which bit of this is covered by the NHS and which has to come from insurance or private pay.I do not believe there is any other answer.

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  • The problem is not peaks and troughs in demand, for which something like a vascular surgery hub is an answer, but under capacity due to lack of money. I cannot see how any hub will provide the level of appointments and organisational continuity for less than the c£20/appt we offer now. How can someone explain opportunity cost to NHSE and HMG? Why trust GPs to deliver 360000000 appts per year but need a whole new expensive service for the 360000001st appt?

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  • 25 appts per day? Marvellous. I had 99 triage calls / appts on Monday as Duty Dr before 12:00 (not to mention over 100 meds managements). Does anyone in NHSE have ANY idea how much work we deal with day in day out. If I see 12 that morning, multiply that by 20 for the other surrounding practices and suddenly we've to find the clinicians to deal with the other 1700 appts that morning in a small rural town..... at least we've got brave, strong leaders in the RCGP / GPC to make it all go away!

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  • We have one of these in our area, - staffed by local GP partners for £90 per hour. Most issues end up being - "go back to your GP for further management". Given that they do have access to pt history, - could do better in 15 minute appointments.

    Rarely see them not go through their list quickly and finish early.

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  • thanks
    gives me time to colour in book from rcgp stress relef

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  • This is the way the Suffolk PM Challenge Fund service works (we call it GP+) and the feedback from practices is very positive. Clinicians like working in the service so we don't have any problems staffing it (and only a tiny number used to work in Out of Hours so its not diverting capacity from there). We have no reports of GPs reducing shifts in practices to work in our service.

    Our conclusion is the supply of GP time, using an economics phrase, is elastic i.e. in a nice positive working environment, lots of support, IT works (mostly!), decent pay, 15 minute appointments etc means GPs are happy to do extra shifts now and then, on top of their practice work.

    I realise this does not reflect the views on here but it is our experience.

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  • Pulse once again lapsing into its childishly divisive 'NHS Managers' language again - NHS England does not represent all managers in the same way that the Daily Mail's editor does not represent Pulse's.

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  • Good news. We realise that we need longer consultations to improve patient care and safety (as others services have become fragmented and with an ageing population) but that we do not have enough extra consulting rooms for doctors due to a lack of strategic planning over the last 20 years. 15 minutes is urgently needed for patient safety and so is an overflow system because clearly 100+ consultations before lunch is potentially unsafe just in terms of workload alone.
    When all practices have been driven to the point of bankruptcy and into mergers we will be working as one "Hub" organisation anyway so longer term continuity isn't going to be an issue. It is just the getting there that is proving difficult as no one is having honest conversations with us that this is what they really want and are forcing us towards by financially breaking us and overloading us with work and administration.
    Safety is critical and so is finding a way to cap workload. This offers a solution and may stop the huge exodus of GP partners who prefer to work at the Hub where workload is capped. It needs to be brought in quickly not in 2020 or thereafter and it should save the NHS from burnout, legal fees and make patients happier, better educated and more empowered. It isn't what the voters will want (who aren't being asked- they would want a properly funded in hours local Gp service rather than a distant Gp service further away available with longer hours) but as usual this will be declared a local decision so politicians and centrally they can wash their hands of this decision to start the end the local doctors surgery in its true sense of the word. Once patients are used to visiting the Hub for routine care they won't fight to stop the local surgeries closing.

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