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GP practices face crackdown on walk-in centre attendances

GP practices with high numbers of registered patients who attend walk-in centres face tougher scrutiny of their opening hours, under proposals from Monitor.

The patient watchdog has recommended that managers should ‘identify and correct any access or other problems’ in GP practices that may be contributing to high attendance levels at walk-in centres.

Monitor also suggested - in the final version of its review of walk-in centre closures published today - that practices could be incentivised financially to ensure their registered population attends the practice over walk-in centres.

In a previous ‘interim’ report, Monitor concluded that GPs may be encouraged to ‘raise their game’ by increasing competition for funding between GPs and walk-in centres.

In the final report, Monitor said: ‘We recommend that commissioners work with any GP practices that have a high number of their patients using a walk-in centre to identify and correct any access or other problems.’

It added: ‘[L]ong-term solutions are needed to address the difficulties that some patients have in accessing primary care, and the difficulties some GP practices have in responding to increasing demand.’

Monitor also said there was ‘confusion’ over commissioning responsibility of walk-in centres, especially in those that were GP-led and also kept a registered list.

The report said: ‘Current payment mechanisms for GP practices and walk-in centres discourage commissioners from offering walk-in centres, even where these may represent a high quality, cost-effective model for delivering services.

‘In addition, the payment mechanisms do not strengthen incentives for GP practices to improve the quality and efficiency of their services so that their patients are more likely to choose the GP’s services rather than a walk-in centre.’

It comes as Monitor is already involved in a review of payment systems which it is jointly overseeing with NHS England. This is expected to suggest reform of hospital payments, after the bodies suggested that the current payment-by-results system ‘acts as a barrier to integrated care’.

However, in the report, Monitor also said the two bodies would develop a longterm, ‘coherent’ payment strategy for primary and secondary care, especially enabling ‘emerging’ models for integrated care across primary and secondary care.

It said: ‘Monitor and NHS England are working to improve payment mechanisms for urgent and emergency care services. This includes trying to better understand the costs of providing these services.

‘NHS England and Monitor have also pledged to work together to ensure there is a coherent payment system for both primary and secondary care, particularly for emerging new models of delivering integrated care across primary and secondary care settings.’

‘This is an issue that we will continue to consider with NHS England as we develop our long-term strategy for the payment system.’

Monitor’s executive director for co-operation and competition Catherine Davies said: ‘Our advice is designed to help commissioners make these services work better for patients, although ultimately what is best for patients will depend on local circumstances.’

BMA chair Dr Mark Porter, said: ‘The BMA has always said that the provision of walk-in centres should be based on patient need. Rather than the expense of setting up new centres, GP practices could have been offered extra investment to improve access and expand premises.’

Readers' comments (11)

  • Over the last few years I have seen patients attending WIC just because it suits particular time frames rather than attend a GP appointment offered to them the same day!!! Who will MONITOR them !!!

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  • I have just completed an survey of A&E attendances by our patients over 3/12 and found 7% of young children see the GP and A&E in the same day about the same thing - often trying to get the antibiotics we didn't give. I considered about 38% A&E attendances to be appropriate, rising to 54% in the over 75s. Many of the attendances were at weekends.

    This is the tail wagging the dog. It's no good penalising GPs and destabilising surgeries with financial penalties. That will make the problem worse. Patients need to take a greater responsibility to use the services properly. The whole thing is on a shoestring where primary care is concerned so it is unlikely patients can see the doctor of their choice at the time of their choosing. Most are pretty reasonable. A few are complete idiots.

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  • I hope there will be a decision to make a suggested number of appointments per 1000 patients. Then those who have high numbers of walk in users/ A+E attenders have their appointment numbers compared to this standard, rather than automatically punished.

    I suspect it will be the later though, that is cheaper and may save money for the government.

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  • Fine just close WIC and give GPs the money to improve access, not exactly rocket science.

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  • So now we must manage access to A&E and WIC...good grief. Next the pharmacies will complain we're sending too many there!

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  • 1) Move your practice further away from a Walk in centre immediately- its the biggest driverin the stats.
    2) Gp's contracted/funded to provide assessment on clinical need within 48 hours.
    public choose to go to service comissioned "on demand and finished within 4 hours"
    3) This is about capacity provision to an engineered "need" of instant access.

    The government are slowly waking up to the fact that when they have introduced the plurality of primary care provision the "cost per contact" of all new systems is higher than the " cost per contact" in old fashioned GP Primary Care.

    The Government either do not have the wit ,
    or
    do and also have the mendacity to appreciate that its the costs of the "instant" access that makes the other providors dearer.

    If they are wed to instant access , instant access to GP's needs an investment in premises and staffing and cost per contact will rise.

    Move the work but not the monies and this is a mendacious engineered "constructive termination" of GP providors.

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  • Peter Swinyard

    Andrew Mimnagh's perceptive account should be promnulgated to whomever in this new system actually decides on such things.
    How many people decide to take an opinion from the WIC and then from the GP and probably pop in to Casualty as well?
    Walk in Centres do have their virtues but investment in core general practice has more...

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  • Bornjovial

    Andrew Mimnagh is right on the spot.
    The 2004 contract was done when the average consultation was 2.5-3.5 per 100 patients/GP. We are closer to 7 now and income has fallen. So WIC are not a solution to a problem but a solution looking for a cause.
    The solution is for GPC to negotiate a cost per transaction contract for GP`s- so "lazy GP`s" who see less patients will get less money.
    I suspect the government knows fully well how much that will cost them.

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  • Paul Joshi,
    Sorry, suggestion of unintended consequences!
    I have relatively small surgeries due a combination of proactive management, discouragement of illness behaviour and many other factors, in spite of having above average list size.
    If my income depends on patient contact I, and all my colleagues will simply bring everyone back on a weekly/daily basis! I suspect this would be very popular with some patients but neither good medicine or economics!

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  • Bornjovial

    Hi Richard.
    Just to clarify the phrase was used to deflect criticism from press and politicians who thinks we are not busy. We all know proactive management and appropriate health seeking behaviour is the best for the economy.

    However average punter wants what he wants when he wants it. We live in a 24 hour culture and someone has to pay for the convenience! The alternate is privatised medicine where only those can afford can see a doctor. A small minority would prefer such a system.
    Compared to £90/consultation by pvt GP`s we earn between £1 to £5 based on consultation rates and overheads. No GP will be worse off than at present even if your consultation rate is less than 1/patient/GP/yr which is why the government can`t afford the same!

    Hope no GP changes their practice of medicine greatly based on the nature of contract!

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