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At the heart of general practice since 1960

Seven-day GP access can work well, if implemented carefully

Dr Peter Thomas argues that in Bury, seven day access has worked very well

dr peter thomas 3x2

 

Without a doubt, the Government’s flagship policy to offer seven-day NHS services has become a contentious political issue.

On one hand, we have Health Secretary Jeremy Hunt pushing for seven-day services to meet the rising expectations of patients and to improve outcomes outside core hours. And on the other, we have many groups voicing concerns about whether seven day services are achievable within existing resources, particularly in general practice where services are already overstretched.

It’s a challenge not to get drawn in by either side of the debate, each with their own legitimate arguments. But politics aside, if we honestly ask the question ‘are moves to offer busy working patients and parents more convenient appointments in the evenings and at weekends a good thing?’ in Bury, our response has been a resounding yes.

That’s not to say that we deny the enormous challenges facing general practice, we don’t. But we also can’t deny the fact that working patients tell us time and again that they’re struggling to get to see us.

So what do these patients do? Yes many soldier on, but many will end up in other NHS services like A&E, often inappropriately, especially when we acknowledge the role of deprivation - rates of A&E attendance and non-elective admissions, are twice the level in the most deprived quintile versus the least. And I know I don’t need to spell out the pressures facing A&E departments across the country, particularly at this time of the year.

Evidence tells us that access in primary care can change patient behaviour and reduce walk-in centre, out of hours and A&E attendance. So in Bury, we decided to act.

A successful project was already offering extended access in the Radcliffe area and had resulted in a reduction in attendances of 25% at A&E, 14% at walk-in centres and 38% at the out of hours service.

Ultimately, we have been able to offer extended access to all 195,000 patients registered all 33 Bury GP practices

Based on the successes of this project, GPs in Bury (under the banner of Bury GP Federation) applied for funding from the Prime Minister’s GP Access Fund so that we could properly resource the extension of this successful service.

Our vision aimed to provide all Bury patients with more choice, convenience and flexibility when accessing local GP services and to reduce variations in quality of care and increase patient satisfaction, reduce unnecessary A&E attendance and ultimately develop a service that was sustainable.

The Radcliffe centre was already successfully providing GP services from 6.30pm to 8pm weekdays and 8am to 6pm on weekends for patients registered at six local practices. Using the learning from the pilot, we expanded this ‘hub and spoke’ model and added four more ‘hubs’ in accessible locations across the borough.

All this was possible because we were able to sufficiently invest in resourcing the development of robust systems, structures and processes, all of which could not have been done within existing capacity as an adjunct to existing people’s roles and within existing budgets.

Key to the success of our extended hours’ project in Bury has been the ability to make all patient records accessible from each of the five hubs, something we know other areas have struggled with. We’ve been in the fortunate position of all Bury practices being on the same clinical system which has helped, but this alone would not have been sufficient. Positive collaboration made possible by working together in a federated model has been crucial to our success.

Ultimately, we have been able to offer extended access to all 195,000 patients registered all 33 Bury GP practices. But we haven’t stopped there. As well as the additional 1,400 GP appointments being offered each week, each of our practices has signed up to offer phone consultations as a routine alternative to face-to-face appointments.

Many have quoted a lack of demand for Sunday appointments (as reported in the Wave 1 Evaluation Report) as clear evidence of a flaw in the move to offer seven day services. That hasn’t been the case in Bury where Sunday demand (albeit lower than weekday evenings and Saturdays) has been steady and we have simply adjusted our resourcing levels to match demand. Our experience also tells us that Sunday appointments can alleviate pressures on practices that arise from Monday morning demand.

Other criticisms centre on the resourcing of extended access, but I believe that if every GP in our borough volunteered to do one extended access shift a month, we could sustainably resource our extended access service.

I believe that seven-day services (if adequately funded) will maximise primary care’s potential to offer a responsive population-based locality model which will enable true community engagement to deliver more person centred care. That said, discussions with commissioners are ongoing regarding the future model of extended access.

The contention surrounding seven-day services is unlikely to abate any time soon with each side vociferously arguing their case. But for patients it’s a no brainer, they need flexible seven-day services that fit around their lives. And for us, our focus needs to be on delivering the right care, in the right place, at the right time to achieve the best outcomes and the value for money.

Dr Peter Thomas is organisational medical director for Bury GP Federation and a GP in the town

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Readers' comments (15)

  • Needs to be paid for properly and not have funds taken away once established.her is just not the workforce to do this pie in the sky rubbish.Afterall we do have a seven day service already.why not put this money into out of hours which would be too obvious.

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  • utter rot
    total outrageous waste of money
    many many far more pressing nhs priorities before an ethical person would even consider introducing such garbage not present anywhere else.as if the nhs is overflowing with gold for such fripperies.
    as above ooh already exists as does the right of employees to take time off working hours for medical care..if govérnment can legislate the new minimum wage on business..this is somple.
    ludicrous

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  • I am sorry but I simply cannot agree with this rubbish.

    There are not enough GPs, I repeat THERE ARE NOT ENOUGH GPs.

    What happens when you start requiring GPs to work extended hours when there are not enough of them? There will be less to provide urgent care in the out of hours. It's not rocket science. A lot more investment is required in OOH services to prevent unnecessary ED admissions. Why would little Johnny with his verruca go to ED anyway? An if he does, there needs to be a proper A/E diversion system in place.

    I cannot believe that intelligent people fail to understand basic economics about business and profitability. The ONLY reason why Tesco is open 24/7 is because it makes money by doing so. If you are not running a business for profit, why on earth would you want to extend your opening hours in a cash strapped NHS? If anything, we should consider reducing our hours - 9 to 5 daily with maybe one late evening for workers.

    We have extended hours for routine stuff. If it's urgent, there is OOHs. If I want to get my smear done on a Sunday afternoon, I should pay heftily for the privilege and not expect some poor nurse to do it for the same pay as a weekday.

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  • What's the opportunity cost?

    £30-£50 per appointment is far more than that to fund additional appointments in currently running GP services, appointments that would reduce some of the in hours GP pressures, thus preventing burnout and GPs reducing their sessions.

    It isn't about how many X thousand appointmens have been added. It's about why X thousand appointments at the weekend are more important than 2X appointments during the week.

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  • Funding, Funding, Funding...and bollox.....

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  • Ivan Benett

    Well done Peter, clear and articulate....Shaba, unfortunately, has got the wrong end of the stick again. Pitty, as she is a course organiser and is in charge of delicate minds. Don't worry about those who are so brave as to post 'anonymously'.

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  • Ivan- I cannot wait to share your comment with my VTS groups. Insulting and patronising to the extreme.

    Instead of passing judgment on my teaching skills, how about actually responding to the points in this post(as well as previous blogs)

    If a religion is a delusional faith, then 7 day working has become a religion to you.

    But fear not- you will be retired in a few years no doubt. It is the future generation, ie- my trainees, who will carry the can.

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  • I was under the impression that the government wanted to address the weekend effect of increased death rates in hospitals. Continuing to maintain an efficient out of hours GP service is essential but I am not sure how routine GP work at a weekend would affect this phenomenon, so what is the point?

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  • Can someone please tell me exactly what problem is being solved by 7 day access. Patient's inability to get an appointment is NOT the Cause of a problem it is the Effect of a
    problem. Adding more resource is not an answer unless and until the correct problem/s is/are identified.

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  • I agree with Shaba.
    Exponents of routine 7 day GP access seem to ignore the damage done to OOH services through unequal competition for the doctors available and to be unable to explain satisfactorily how extended routine opening can logically have any effect on A&E attendances. We should sort out normal hours, OOH, the GP shortage and inadequate primary care funding before even thinking of offering even more for less.
    Moreover, workers should not be forced to obtain routine medical care at a weekend/evening from a random doctor with no long term interest instead of being able to see their own doctor of choice during normal hours. Far from favouring working people, this set-up will disadvantage, by removing choice of practice/GP, those whose employers force them to use extended hours schemes such as these because they are available.

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