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Independents' Day

GPs to offer half-hour appointments as paramedics take on home visits

Exclusive GPs will be able to offer extended appointments that could last up to half an hour, after a group of local GP federations received £42m in funding from the GP Forward View.

According to GP leaders in Manchester, the funding injection has allowed general practice in the city to 'breathe' by paying for extended appointments and a wider clinical workforce in practices.

This includes hiring paramedics to take on nearly all home visits in the city, freeing up time for GPs to spend on patients with complex needs.

Dr Tracey Vell, chief executive of Manchester LMC, told Pulse that the extra funding ‘will make every GP have the capability to go to 20-30 minutes of quality, continuity-of-care appointments’.

Dr Vell added that with the extra time, GPs are able to spend longer with patients with complex needs, which she said is where continuity of care ‘really kicks in’. 

She said: ‘Continuity is less important for some populations, but what we are doing is giving patients that choice, we are not making it for them.

‘We are saying you can see your GP on this day, but if you don’t mind seeing any GP in a different setting on the same day, you could choose that.’

She added that the extended appointments scheme is 'assisted by the time we save in not doing home visits, or not every home visit'.

Dr Vell said that some of the £42m was allocated for 'additional workforce', adding that some practices have access to 'paramedics that are starting to do home visits for GPs', while a clinical pharmacist is now stationed in every GP ‘hub’.

GPs in Manchester operate in hubs of up to six practices, covering between 30,000 and 50,000 patients each.

The hubs are divided into ‘local care organisations’ (LCOs), with between five and six hubs in each of 10 LCOs across Manchester.

One LCO went out to tender earlier this year for a 10-year contract worth £6bn to deliver all non-acute healthcare except core GMS contractual services to 600,000 patients.

This comes as Dr Robert Varnam, NHS England’s head of general practice development, told delegates at the RCGP’s Annual Conference that GPs have 'chosen' to work in 10-minute appointment slots, which he said is 'unethical'.

Meanwhile, a review backed by the Chief Medical Officer found that a current average 9.2-minute GP appointment ‘does not give sufficient time' to discuss treatment options.

Healthcare devolution in the 'Northern Powerhouse'

Former Chancellor George Osborne announced two years ago that the NHS in Manchester  would become devolved from central Government, as part of the Government's 'Northern Powerhouse' plans.

The deal saw the local authorities, alongside CCGs, given the freedom to jointly commission health and care as they pleased in the local economy.

Since then, in an even more far-reaching shake up, NHS England has unveiled plans to devolve responsibility for commissioning to care organisations themselves.

This will see, in the long run, all of a current 44 Sustainability and Transformation Plan (STP) areas become 'accountable care systems' in future.

NHS England has named Greater Manchester as one of nine 'likely candidates' to become one of the first such ACSs.

In return for becoming an ACS, NHS England has promised the organisations ‘more control and freedom’ over their regional NHS including receiving devolved national GP Forward View, mental health and cancer funding from 2018.

Readers' comments (27)

  • I don’t have a problem with home visits. I quite like getting out of the practice to do them, but it’s when I get called to visit a 36 year old who has diarrhoea and can’t get in I struggle. Most of the visits I do can be done by a paramedic. There is room for help here, they can leave us with all the complex visits. But is the bristish public willing to pay for this en masse? Or should many of these visits just come down to the practice.

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  • Standards of English continue to go down. "Received" : i. before e. except after c. (see line 3 of this article).
    As a retired GP, I feel sorry that the holistic nature of general practice continues to diminish. Visiting one's patients at home used to be an important part of looking after them. Now it is 'GP by committee'; with Nurses, Physicians Assistants, paramedics etc all in on the act. Many female GPs are part time, and patients complain that they never see the same doctor twice. Continuity has gone, to the patients' detriment. Life moves on!

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  • General Practice on death bed ...another way of destroying the practice...Is the GMC monitoring paramedics at doctor's level??

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  • I'm a single handed GP who does 2 visits a week
    I don't think this would give me much extra time.
    When I was a trainee almost 30 years ago I think the great and the good in the RCGP suggested that the a GP should treat around 1200 patients. If there was adequate funding for this then that would have a much bigger impact

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  • John Verity........general practice has changed over the 25 years I have been a GP.......there is no time in the ever lengthening working day to visit patients who are often quite able to leave the house for hospital appointments, hair appointments, dental appointments, visits to family and holidays abroad. We are seeing patients more frequently than in the past, with more complex conditions, more medications are available, more monitoring is needed, there is more paperwork to do, and we are now managing more conditions in primary care than ever before. This is before you add in QOF, CQC, appraisal, revalidation etc etc ad infinitum.
    It is not only female GPs who are "part time".... And I use that term loosely. When I started out I worked "full time" over 5 the days have lengthened (now averaging 12-13 hours, possibly without even a coffee or toilet break, never mind a lunch break) I, like many of my peers, have had to reduce the number of days worked in order to have some semblance of work life balance, so am now doing 3 days a would probably class this as part time, but this is full time hours. No one, male or female could possibly be available from 08.00 to 18.30pm EVERY day......

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  • End of the line?

    Working in ooh .. one is all too familiar with fielding a call from the paramedics ... with an agenda of avoiding a+e and admissions ..
    Some of the public have already been abusing the ambulance service as a sort of emergency visit ..
    It would be interesting to see how much each ambulance call out spends with each patient
    You get the impression with some cases that the paramedics may have been there quite a while

    as with all things if you are doing one thing you are not doing another ... In my opinion the ambulance service needs to have a certain amount of stand by service like the fire brigade to allow blue light access to at risk patients within 1 hour

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  • We have a home visiting service (DN and paramedic with some partial CPN coverage). We triage DV requests and book them in the same way we book the 8-8 GP Hub (which includes a physio). It saves us several visits a day, I like it.

    Things are changing, but if anyone thinks this means 30 minute appointments they have extrapolated alot further than this justifies!

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