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Analysis: How the Government’s seven-day GP access scheme could work

Dr Ivan Benett describes his experience as clinical director of NHS Central Manchester CCG, whose scheme was hailed by the Government as a prototype

Our overriding ambition is to provide a service for the people of central Manchester that is consistent and of the highest quality.

The first step is to be available when people are ill, or believe themselves to be ill. This means increasing the capacity in primary care to see more people at the times they are able to access the service.

So, our aim is to begin to offer longer opening times by this Christmas to the population of one of our localities – around 50,000 patients. Each locality has about eight practices. The £500,000 scheme will eventually see one practice in each locality open for business from 8am to 8pm on weekdays and for three hours on Saturdays and Sundays. When surgeries are closed people will be seen at this locality hub.  We want people to come to this service rather than go unnecessarily to A&E, especially between 6pm and 8pm. We also aim to be able to match the standards currently delivered by the out-of-hours service for responsiveness to urgent demand.

The extended access scheme will only work if practices can share patient records [between GP practices], after appropriate consent from patients. So that will happen when we start and then we will roll it out more once we learn what the pitfalls are.

In the medium term, once we get the technology working, I would hope that we could progress to sharing electronic patient records with emergency and urgent care services.

We are still working out the financial details but GPs will be paid roughly the usual fee they would have earned under the extended hours DES. No one doubts or underestimates the challenges of resource and workforce capacity, but without timely access the rest will not be possible.

Wouldn’t it be wonderful if in three years’ time outcomes improve, extremes of variation reduce, and all our patients can say ‘I am able to access the health service, at a time that I need it, and am confident of getting the best quality care when that becomes necessary’?

Readers' comments (40)

  • I do not think this will work because the demand is too great. We do not have the capacity in general practice unless we have different GPs doing this .

    I have no capacity to take on extra work. We each get one life, however long we are given. I work to live and not live to work. I am a woman doctor with children. I have a partner who will support me if I leave my practice. There are many more like me.

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  • We costed the reduced extended hours DES money to equal a loss so stopped doing it.

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  • The government has found a way to destroy traditional general practice. This will break the back of continuity. Soon we will have corporate general practice staffed with a succession of locums.

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  • "The first step is to be available when people are ill, or believe themselves to be ill."

    This simple statement just about sums it up. Forget about patient education, forget about negative reinforcement of illness behaviour, forget about any punitive measures for abuse of services. Let's just open all hours.

    We have a service for patients who are unwell outside of core hours. IT'S CALLED OUT OF HOURS. It just needs better access to GP records and an increased investment.

    How can you think that the GPs involved in this scheme will be any better off than the out of hours provider, when they are unlikely to know the patient and be gleaning everything from the notes. Why not just ensure your out of hours provider has access to these?

    Ivan - I'm not sure if you are profoundly naïve or profoundly ambitious because you are strolling straight into the bowels of the Tories.

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  • 'The first step is to be available when people are ill, or believe themselves to be ill.'

    few points ;

    - patients can get ill 24 hours a day 7 days a week not 12 hours a day -> the implication being that actually this is a run up to 24 hour availability.

    - will these locality surgeries that are open actually be able to deal with the presenting problem e.g. routine referrals, repeat meds, sick notes etc which normally get bounced back to the registered practice?

    - has any work been done on analysis of demand? i.e. no point having a service which can't manage the presenting problem.

    - will the practice opening at 8 to 8 effectively be providing care for another surgeries patient. what do you do with patient's not happy with the current surgery wanting a second opinion etc.

    I don't think this has been thought through and it would be useful to have an analysis of the actual demand and what care is needed.

    I also think this is the 'thin edge of the wedge' and as already mentioned is unlikely to deal with the massive predicted demand in care i.e. increase in population and change in demographics.

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  • Its Just gets worse.

    Creating inefficient capacity to deal with patients to be told to see their usual GP the next day, because these aren't the doctors who have continuing responsibility for the patients they are. What you're describing, can be achieved with increased access to records and investment into the ooh service. Its also not cost -effective at the extended hours des rates.

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  • We will all just take it always have all talk no action all noise
    2 years down the line this will be part of routine work
    If any renumeration was there there will be another round of austerity and we will do it for patients as they re the most important
    Pt will happily pay the usher the lawyer the restaurant the dodgy person in the dark corner the people in big chairs in big offices in far away places out of control entertainers whatever's their views on life
    Dr are all what's the word sounds like brewed

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  • Let me help.

    We run a daily open surgery for a patient population of around 10% of your locality size.

    We restrict to those who believe themselves to be ill, like you propose.

    Until we started to cap we got over 30 patients in the winter per session.

    Based on this I predict a demand of at least 300 patients for your weekend sessions unless you actively discourage attendance, which would defeat your aims. This might be an underestimate.

    That equates to 3000 GP minutes for 10 minute appointments.

    You propose 3 hour opening so that is 1000 GP minutes an hour - to achieve this you need 17 GPs working in the practice at any given time.

    Have you REALLY thought this through? Really?

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  • Ahhhhh, Ivan, I have finally got it!
    You are actually on the side of the ordinary, hard working GP and your aim in life is to set up a service that is designed to prove once and for all that what the government is demanding is totally unachievable.
    Within 6 months the gold plated, super duper access, all singing and all dancing service fully supported by the government will have very publicly collapsed and demonstrated what we are all saying, leaving the rest of the profession to negotiate sensibly.
    Thank you.

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  • Demand will be huge.
    What will this service offer, for example, to someone who wants a sick note extension, or to discuss an ongoing problem that has been partially worked up by their GP? - See your own GP in the morning methinks!
    How will you control those patients who just want a second opinion etc etc
    I agree will all these comments. Yes I am a part time female GP with a family, a life, and an ever increasing desire to leave this gutless profession.

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