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Gold, incentives and meh

Seven-day GP access pioneer hails cut in unnecessary A&E attendance

Exclusive The leader of a seven-day working pilot lauded by the Government has claimed the scheme has cut the number of unnecessary A&E attendances by more than a quarter in three months.

An early evaluation of the pilot scheme run by NHS Central Manchester CCG also found that the number of patients who said they attended A&E because they were unable to get a GP appointment had ‘halved’, the CCG clinical director Dr Ivan Benett told Pulse.

However, local leaders have said that extending access should not be a priority and warned these extra appointments do not receive the full clinical support available in hours.

Thie evaluation results follow the Government’s announcement last week of £50m worth of funding for 20 schemes across England to pilot extended hours access for one year.

The Central Manchester pilot, which was one of six in the north west of England was mistakenly hailed a success by the DH before it had actually begun.

The six schemes together received £2m worth of ‘winter money’ from NHS England’s local area team to reduce pressure on emergency services, and saw GP practices in four locations work in hubs to provide access from 8am to 8pm on weekdays, and between 8am and 6pm on Saturday and Sundays.

Dr Benett said the CCG now thinks that the project could become ‘self-funding’ because of the reduction it has achieved in hospital pressures.

He said: ‘We estimate this have led to a reduction of 27% in primary care attendance at Central Manchester University Hospitals  NHS Foundation Trust A&E compared to last year. There has also been a reduction of 50% of people turning up to A&E saying they are because they could not get an appointment with their GP.’

He added: ‘I’m confident that the extended hours will provide a better service and reduce urgent care activity so it will be self-funding.’

But Dr Tracey Vell, medical secretary of Manchester LMC and a GP in central Manchester, said there were concerns with the pilot locally.

She said it was a ‘duplication of current GP out-of-hours services’, adding: ‘We do not feel that routine appointments at these times are fully supported with pathology and other investigations.’

‘Politically, we feel that access for our patients is already great and that money could be spent on other projects.’

Last week, Pulse reported that the Government has not committed to continue to fund its nationwide scheme beyond next April, instead hoping they can prove self-sustainable and be carried forward commissioned by CCGs.

However, Dr Paul Charlson, who is the vice-chair of Conservative Health and a GP in Brough, East Yorkshire, said that a nationwide push for extended access remains at the heart of discussion within Tory circles ahead of next year’s election.

He said: ‘It is such a hot issue with the public that understandably the Government is keen to pick it up and encourage it. Whether that is by carrot or stick depends on a number of factors - one being GP recruitment.’

Dr Charlson added: ‘I personally would like to see a situation where there is a minimum number of face-to-face consultations per week based on list size, which I know has been talked about. This appears fair as there is significant variation in this across England which is not wholly explained by demographics.’

Asked about future plans for extending GP access, the DH said it would be ‘inappropriate to comment’ before next year’s GP contract negotiations had begun.

Pulse reported last week that experts have warned that stretching access over seven days threatened to hamper continuity of care and derail the health secretary’s bid to improve care of vulnerable elderly patients.

Related images

  • Dr Ivan Benett - online
  • Taken from issue
  • Dr Tracey Vell 330x330 online

Readers' comments (48)

  • The govt had already decided it was a success!
    They were never really going to report failure were they!

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  • Perhaps I am being stupid - all that has happened is that these patients are seeing a GP doctor instead of a AE doctor. It doesnt prove that that what was an unnecessary AE consultation was a necessary GP consultation. Its just pandering to impossibe patient demand.

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  • 'claiming' and hard data are two different things.

    let's wait until the evidence is presented (if it ever is)

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  • "Its just pandering to impossibe patient demand."

    This is exactly the problem. Unfortunately the CCG will be happy (if the above is to be believed) because GPs pandering to inappropriate demand is cheaper than A+E pandering to it.

    The first poster is also completely correct. Since this was deemed a success before it had started, is anyone surprised about this "result".

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  • The peaks in A&E attendances seem to be in hours and concentrated Monday to Thursday.
    Has this Pilot reduced these attendances, and if so, has anyone looked at the changes in patterns?

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  • I feel this smacks of the Tesco 24 hour mentality! Why on earth would I go to Tesco at 3am? oh I know why, because I can!

    We have the data to prove who fills our late opening slots, and anyone hazard a guess?

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  • Hard figures would be useful

    "He said: ‘We estimate this have led to a reduction of 27% in primary care attendance at Central Manchester University Hospitals NHS Foundation Trust A&E compared to last year."

    3 instead of 4?

    "There has also been a reduction of 50% of people turning up to A&E saying they are because they could not get an appointment with their GP."

    1 instead of 2?

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  • I agree with anon@10.03
    Why applaud increased GP workload when we are already struggling? Where are the schemes to cut unnecessary GP attendance?

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  • Bob Hodges

    anon 11:26

    Exactly!!

    If 30% of attendee didn't did to go to A&E - what proportion of those didn't need to go to a GP either?

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  • ".. the number of patients who said they attended A&E because they were unable to get a GP appointment had ‘halved’.."

    Presumably the time of attendance and reason "unable" to get a GP appointment was recorded to allow proper analysis before any conclusions can be drawn.
    Opening for longer hours (with ultimately fewer GPs as a likely result of this policy) is not necessarily the solution - opening for the same hours with more GPs and hence more appointments might be at least as effective but lacks headline-grabbing appeal.
    We need a definition for "unnecessary" A&E attendance and to know what proportion were deemed "necessary" GP consultations

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  • ps we read elsewhere that after the shining success of these pre election schemes it will be rolled out and disappear in general ccg funding..who says any money will pass to primary care to make it self funding.?how very naive.
    ps why duplicate existing out of hours services?
    ps why pander to and worse even encourage yet more inappropriate dr dependent selfish demands not needs..so transferring scarce resource away from the latter.
    i remain sceptical this is a rational priority above others that are screaming at us.

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  • This comment has been moderated

  • Will an MBE "for services to medicine" be enough or would you prefer an OBE ? I just can't seem to remember the pecking order.

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  • no ,1.14 i think he will deserve the same accolade as lord darzi..and the same glowing regard from colleagues currently under desperate pressure.
    another great pioneer in the making................................

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  • Ivan Benett

    I am happy to respond to individual questions from named people, please email me at ivan.benett@nhs.net.
    On a few general points, the evaluation is by no means complete and I have said since the start that we need at least 12 months to get a feel for full impact. The reporter asked for early data, and that's what she was given. Neither would I ever claim causality between extended hours and reduced A&E activity since this pilot was not set up in a way that can easily show this 'beyond reasonable doubt'. I think we will be able to show 'on the balance of probability' that extending hours of service has made a change for the better.
    What I can say is that compared to last year at the same time people registered with Central Manchester practices are attending less at A&E for 'Primary Care ' type issues. So Central Manchester practices WITHIN the whole system are doing something different from most of the rest of the country.
    Further impact will be achieved once NHS 111, A&E and OOHs can directly book in to the extended hours, which we are working on right now.
    We will never convince those who are idiologically opposed to providing a service for our patients, some of whom chose to comment anonymously in these columns. What I'm interested in is investing in Primary Care to deliver a service our patients pay for and deserve. Those who want investment in Primary Care are getting just that in our extended hours service. No-one has to work more if they don't want to. Patients see a doctor with access to their records. Everyone is a winner

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  • Unlike Dr Bennett I do not believe many GP's are ideologically opposed to the concept of better access.
    Indeed I congratulate my colleagues who continue to soldier on providing OOH care.
    I do believe that those of us who work full time at the coal face are all too aware of the constraints of limited resources and the 'tough choices' in allocation of them.
    The short term money provided to set up these pilot schemes is surely a poisoned chalice the contents of which have foolishly been supped.
    Next year the poison will take effect after the contract negotiations.
    Those few remaining GP's who remain will be expected to provide 7 day access without new money ie for free.
    At least there was one hint in the article that the Government may have some awareness of the recruitment crisis -will that alter their negotiating tactics?
    I won't hold my breath.

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  • You talk about savings for CCGs but will this be passed on to practices once the next Government withdraws the initial trial funding? Just stop and think what you are committing your colleagues to.With what democratic mandate do you choose to represent your hard-pressed and impoverished colleagues?

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  • Vinci Ho

    Self funding ?
    Debatable:
    The money saved from reduced admission to A/E is to fund this service as there will be no more '50 millions' after 12 months.
    In real terms, the amount of money will be cut from the core funding of our A/E colleagues . A good way of further dividing us between primary and secondary care ??
    Then if this money is spent on investing currently existing out of hour GP service , can we argue that same 'good' result can be achieved?
    A horse is a horse, a deer is a deer. One cannot confuse people by pointing to a deer and call it a horse . Chinese old saying .......

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  • Vinci Ho

    Well , Sir Alex Ferguson thought he was that right about David Moyes.........

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  • If GPs are open for longer it it is obvious that fewer people will turn up at A/E.It is no more than duplication of OOH services.But then do we know how many of those will be re-attending to see their usual GP?The only way this will be cost effective is if it is cheaper for the patient to see a GP during extended hours than an A/E doctor.However i don't think any of this really matters as extended access is seen as a significant vote winner and will be pushed through regardless

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  • Unfortunately the government is not interested in investing in primary care, they are interested in funding schemes like these. Where funding is used to prove a case for access, with spurious claims for success, which will then become a point of contention that if GPs do not provide this they are letting their patients down and not avoiding A&E attendances as a professional failure! I'm sure at the end of this study you will be able to compare the number of new appointments and the reduction of A&E attendances and the cost of each attendance at practice compared to the reduction of relatively low cost A&E attendances, which you would have to presume as they were 'unneccessary' led to no admissions, and that this has therefore affected nothing costwise apart from minimal savings at the trust end (for which they will save money by not employing A&E doctors as GPs are able to do the work) and not significantly reducing the taxpayers costs. With no empirical figures this would seem like a, neccesarily massive, increase in funding to GPs (that this government is ideologically against wider) for somewhat limited returns in terms of spend in secondary A&E care. I think the public (and the government) would want more investment in acute services than money for access 24/7 into GPs pockets to provide something they could provide anyway without huge investment. The case may be put simpler that this could easily be achieved with changes in Practice opening hours rather than an investment in 24/7 primary care, as everything mentioned in this article could be easily acheived in that way! please be aware of how any 'evidence' you produce may be used, and define very clearly causality, along with the role and level of funding to avoid the results being open to use spuriously for other agendas. I suggest this information may be collected for other purposes, as can be seen from the generalisations inferred in the article above, and maybe used for the crafting of a stick not the cultivation of a carrot.

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