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GPs buried under trusts' workload dump

PM's flagship 8 'til 8 GP access scheme to be renewed despite doubts over A&E impact

Exclusive: NHS Central Manchester CCG is injecting a further £500,000 to keep its seven-day GP opening pilot scheme running for another six months despite warnings over its efficiency in saving money for secondary care.

The scheme, which was hailed a success by Prime Minister David Cameron before it had even started, will see the NHS England financial sponsorship come to an end this month but the CCG has decided to keep it going until March 2015 with a £500,000 cash injection from its own budget.

The programme, which was launched in December using £500,000 ‘winter money’ investment from NHS England, will now continue to see four primary care hubs offering GP appointments 8am to 8pm on weekdays across central Manchester, while the current three hours on Saturdays and Sundays will be reduced to two hours a day because of a lack of demand at weekends.

However the project has come under renewed fire from the local LMC, which has said the money should be used for projects with a better evidence base. And NHS Central Manchester CCG’s clinical lead Dr Ivan Benett has admitted that although there has been a reduction in A&E activity, it is too early to tell whether the reduction is sustainable.

GP seven-day opening has been heavily promoted by the Government, with the Prime Minister’s ‘challenge fund’ pumping £50m into 20 other schemes around the country for the current financial year. However, as reported by Pulse, it has not committed to continue to fund its nationwide scheme beyond next April, meaning they will only be carried forward for patients if CCGs can make them self-sustainable.

Manchester LMC honorary secretary Dr Tracey Vell told Pulse that she believed the CCG money could be better spent elsewhere.

She said: ‘[I have seen] no valid data apart from numbers [of patients] using it, [but] obviously patients fill any space given saturation is never achieved in terms of patient access. There is no data on whether patients duplicate and see their own doctor or A&E as well… I feel money could be spent on a more inventive solution with more evidence base.’

NHS Central Manchester CCG clinical lead Dr Ivan Benett admitted: ‘I can’t tell for sure if the reduction in [A&E] activity is sustained, because it is too early to say.’

But quoting early indications, he said that the level of A&E attendances was 2.3% down on last year, and he previously reported that the number of patients who said they attended A&E because they could not get a GP appointment had halved.

He said: ‘Overall, comparing current data to this time of year last year, attendances were reduced by about 2.3%. But it is variable, because remember they haven’t all started at the same time. We started with one hub in December and all four localities have been up and running I think since April, so we have not been going at full tilt but gradually increased. Therefore we have slightly different attendances, or reductions as a result.’

Dr Benett added: ‘I do think it will be self funding. If the difference in activity we see is sustained into the future nobody knows, we have to wait and see. But if we can sustain that sort of reduction in activity, if we can demonstrate that, then it will become self-sustaining.’

However he admitted that the £500,000 additional investment has come out of other strands of the CCG’s budget, as well as an increased budget allocation, rather than just money saved from reduced A&E activity.

He said: ‘We have observed some reduction in activity but the way that the funding system works it isn’t quite as simple as then you can take out a certain amount of money. So you have got to find it from various funding streams. It’s also partly funded from increased allocation.’

Explaining why the number of weekend hours were being reduced, Dr Benett said that ‘one of the critcisms’ that the project had received was that weekend slots were ‘not filling up’ but that within the next three months, when some logistical issues were resolved, A&E, out-of-hours and NHS 111 services would be able to refer into the extended access hubs, he was confident they would be full.

He said: ‘That is true, but once A&E and out of hours and 111 come onstream to be able to book in I would anticipate those weekend slots will get filled up pretty easily.’

Please note: This story was corrected at 15:25 as the four primary care hubs offer GP appointments 8am to 8pm on weekdays, not 8am to 6pm as previously reported.

Readers' comments (17)

  • "Lack of demand at weekends" - love it. Can we highlight, frame and pass this on to the politicians and papers?

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  • Vinci Ho

    Question :
    What is the most 'value for money' way to spend £50 million tax payers' money to help your party's general election campaign?

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  • Ivan, you took such a very strong line in these pages and were so certain that you were right.....I think you should publish the facts relating to this project warts and all.

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  • Surely having GPs open all hours merely encourages irresponsibility and gives patients yet more opportunity to present with trivial problems. GPs often complain that there is an 'unsustainable work load' - well perhaps part if the problem lies in us at times not modifying health seeking behaviours - and spending money on weekend opening hours where it could be used to perhaps strengthen the presence if GPs during the day (with a provision to late surgeries for those who are unable to attend during working hours) merely encourages inappropriate health 'demands'..if it's an emergency go to AE, if it's not an emergency, wait till the next day

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  • Is this an extension of hours or an increase in slots?
    The hub offers appointments 8.00 am to 6.00pm - i.e. in hours - and has reduced weekend appointments from 3 to 2 hours per day "because of lack of demand".
    So, surely the only extension in opening times is the 2 hours per day at weekends?

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  • The time is coming to an end for all these propaganda driven distractions from the core issue of enabling gp's to provide reliable consistent care in hours with reasonable continuity.

    Soon the politicians and their media and managerial acolytes will face the judgement of the voters whom they have so grievously failed in their duty of care.

    The nhs is on it's knees possibly with a mortal wound and who is to blame?

    Scapegoating the gp's won't fool the public for much longer, those in charge will have to shoulder the blame at long last.

    It will be too late for many gp's though who have departed the service prematurely due to ill health, burnout or sought early retirement, emigration or an alternative career.

    That inescapable fact is why younger gp's are not willing to take on the challenge and why the political spin and mendacity will at last be shown for what it is.

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  • 7 day opening won't work because it is too expensive .

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  • Anon 10:58pm,

    I hope this happens but I doubt it. They use the same trick as the builders employ - change people in charge every few years, tell customers (voters) their problem is caused by the previous owners using subcontractors (GPs).

    Just yesterday, Jeremy Hunt was bleating on about publicly naming GPs who fails to diagnose cancers. Never mind the government, via LAT and CCG, telling us to cut down on referrals. Another shift the blame campaign by DoH and guess what, we are the fall guys.

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  • Harry Longman

    PM pumps £50m into a scheme, then discovers the pilot hasn't even started, then the pilot delivers less than expected outcomes, then more money is put into the pilot. You couldn't make it up. But thanks to Ivan for publishing as soon as possible - transparency is too often in short supply.

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  • But this isn't a 8 'til 8 scheme is it? The weekday opening is no different from the rest of us and the weekend now just 2 hours on each day because of lack of demand - and this in metropolitan area. So would appear the PM's promise of 7/7 8 'til 8 may be completely unnecessary (even if we could staff it) - who'd have thought?

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  • Ivan Benett

    Theresa McDonnell - the extended availability is 8-8. It seems to have been misreported

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  • Ivan thanks for clarification - perhaps you need to speak to Sofia who wrote the piece

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  • This has been corrected now

  • Ivan Benett

    Well several comments seem to have got the wrong end of the stick. No-one is asking individual GPs to work longer hours. The GPs that do the work with our GP provider collective are local, and volunteer for the extended hours. It's not even that all practices have to open, just one in every 8-10 in each locality. Often they are salaried doctors who wish to flex their hours around other commitments.
    I am cautious about publishing results as we cannot attribute the reductions in A&E activity directly to the extended hours. However, there is a consistent pattern of reduced A&E attendances and admissions compared to the same time last year, which seems to buck the trend from elsewhere. In addition there have also been lots of other initiatives to reduce A&E attendances and admissions, for example treating long term conditions like Heart Failure, COPD and Dementia. We have a project for registering homeless people with a practice. The key is whole system change rather than this single intervention, although extending hours complements all of them. No-one needs to work longer unless they want to.
    I am also willing to respond to any question emailed to me - ivan.benett@nhs.net.
    Finally, I can't really see why some commentators are getting so angry. This is entirely consistent wit the RCGP campaign for more investment in General Practice and a shift of significant resources from secondary care. It also dismays me that so many colleagues can be so frankly rude, while they remain anonymous. Make your point fairly and in an adult way, and I'll look forward to responding similarly.
    Finally, it sounds as though some people are thinking that I'm 'having a go' at GP. Far from it, and in fact exactly the opposite. I believe in General Practice and that it is the answer to the problems of the NHS. I believe this is an opportunity, and absolutely not a threat. I hope that more and more colleagues will see this. Please email me if you have a question. I wont be looking at these pages very frequently, so wont be responding through them
    Ivan

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  • Ivan, you were at the Pulse Live event in Manchester - did you not listen to the debate about whether greater access harmed or helped patient care? The conclusion was that increasing seven day access simply increases demand. Improving GP access will not affect A+E attendances - if it could, out of hours and walk in centres would have done this already.

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  • Ivan Benett

    Anon 4.50. Unfortunately I missed that debate. What you report is not supported by the evidence. I understand the RCGP are looking at the pros and cons of access and the Kings Fund have produced a report recently on the subject. You will also notice a paper in the RCGP journal which suggests that better access is associated with better outcomes. There is also evidence that better access is associated with fewer delayed diagnosis of cancer (topical). So there's evidence that does support better access and very little to the contrary. Please email me and I will provide a fuller response with references. ivan.benett@nhs.net. Please identify yourself as it's hard to conduct a useful conversation with a blank picture

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