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GPs buried under trusts' workload dump

Seven-day GP access pioneer hails cut in unnecessary A&E attendance

Exclusive The leader of a seven-day working pilot lauded by the Government has claimed the scheme has cut the number of unnecessary A&E attendances by more than a quarter in three months.

An early evaluation of the pilot scheme run by NHS Central Manchester CCG also found that the number of patients who said they attended A&E because they were unable to get a GP appointment had ‘halved’, the CCG clinical director Dr Ivan Benett told Pulse.

However, local leaders have said that extending access should not be a priority and warned these extra appointments do not receive the full clinical support available in hours.

Thie evaluation results follow the Government’s announcement last week of £50m worth of funding for 20 schemes across England to pilot extended hours access for one year.

The Central Manchester pilot, which was one of six in the north west of England was mistakenly hailed a success by the DH before it had actually begun.

The six schemes together received £2m worth of ‘winter money’ from NHS England’s local area team to reduce pressure on emergency services, and saw GP practices in four locations work in hubs to provide access from 8am to 8pm on weekdays, and between 8am and 6pm on Saturday and Sundays.

Dr Benett said the CCG now thinks that the project could become ‘self-funding’ because of the reduction it has achieved in hospital pressures.

He said: ‘We estimate this have led to a reduction of 27% in primary care attendance at Central Manchester University Hospitals  NHS Foundation Trust A&E compared to last year. There has also been a reduction of 50% of people turning up to A&E saying they are because they could not get an appointment with their GP.’

He added: ‘I’m confident that the extended hours will provide a better service and reduce urgent care activity so it will be self-funding.’

But Dr Tracey Vell, medical secretary of Manchester LMC and a GP in central Manchester, said there were concerns with the pilot locally.

She said it was a ‘duplication of current GP out-of-hours services’, adding: ‘We do not feel that routine appointments at these times are fully supported with pathology and other investigations.’

‘Politically, we feel that access for our patients is already great and that money could be spent on other projects.’

Last week, Pulse reported that the Government has not committed to continue to fund its nationwide scheme beyond next April, instead hoping they can prove self-sustainable and be carried forward commissioned by CCGs.

However, Dr Paul Charlson, who is the vice-chair of Conservative Health and a GP in Brough, East Yorkshire, said that a nationwide push for extended access remains at the heart of discussion within Tory circles ahead of next year’s election.

He said: ‘It is such a hot issue with the public that understandably the Government is keen to pick it up and encourage it. Whether that is by carrot or stick depends on a number of factors - one being GP recruitment.’

Dr Charlson added: ‘I personally would like to see a situation where there is a minimum number of face-to-face consultations per week based on list size, which I know has been talked about. This appears fair as there is significant variation in this across England which is not wholly explained by demographics.’

Asked about future plans for extending GP access, the DH said it would be ‘inappropriate to comment’ before next year’s GP contract negotiations had begun.

Pulse reported last week that experts have warned that stretching access over seven days threatened to hamper continuity of care and derail the health secretary’s bid to improve care of vulnerable elderly patients.

Related images

  • Dr Ivan Benett - online
  • Taken from issue
  • Dr Tracey Vell 330x330 online

Readers' comments (48)

  • The govt had already decided it was a success!
    They were never really going to report failure were they!

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  • Perhaps I am being stupid - all that has happened is that these patients are seeing a GP doctor instead of a AE doctor. It doesnt prove that that what was an unnecessary AE consultation was a necessary GP consultation. Its just pandering to impossibe patient demand.

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  • 'claiming' and hard data are two different things.

    let's wait until the evidence is presented (if it ever is)

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  • "Its just pandering to impossibe patient demand."

    This is exactly the problem. Unfortunately the CCG will be happy (if the above is to be believed) because GPs pandering to inappropriate demand is cheaper than A+E pandering to it.

    The first poster is also completely correct. Since this was deemed a success before it had started, is anyone surprised about this "result".

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  • The peaks in A&E attendances seem to be in hours and concentrated Monday to Thursday.
    Has this Pilot reduced these attendances, and if so, has anyone looked at the changes in patterns?

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  • I feel this smacks of the Tesco 24 hour mentality! Why on earth would I go to Tesco at 3am? oh I know why, because I can!

    We have the data to prove who fills our late opening slots, and anyone hazard a guess?

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  • Hard figures would be useful

    "He said: ‘We estimate this have led to a reduction of 27% in primary care attendance at Central Manchester University Hospitals NHS Foundation Trust A&E compared to last year."

    3 instead of 4?

    "There has also been a reduction of 50% of people turning up to A&E saying they are because they could not get an appointment with their GP."

    1 instead of 2?

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  • I agree with anon@10.03
    Why applaud increased GP workload when we are already struggling? Where are the schemes to cut unnecessary GP attendance?

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  • Bob Hodges

    anon 11:26

    Exactly!!

    If 30% of attendee didn't did to go to A&E - what proportion of those didn't need to go to a GP either?

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  • ".. the number of patients who said they attended A&E because they were unable to get a GP appointment had ‘halved’.."

    Presumably the time of attendance and reason "unable" to get a GP appointment was recorded to allow proper analysis before any conclusions can be drawn.
    Opening for longer hours (with ultimately fewer GPs as a likely result of this policy) is not necessarily the solution - opening for the same hours with more GPs and hence more appointments might be at least as effective but lacks headline-grabbing appeal.
    We need a definition for "unnecessary" A&E attendance and to know what proportion were deemed "necessary" GP consultations

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  • ps we read elsewhere that after the shining success of these pre election schemes it will be rolled out and disappear in general ccg funding..who says any money will pass to primary care to make it self funding.?how very naive.
    ps why duplicate existing out of hours services?
    ps why pander to and worse even encourage yet more inappropriate dr dependent selfish demands not needs..so transferring scarce resource away from the latter.
    i remain sceptical this is a rational priority above others that are screaming at us.

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  • This comment has been moderated

  • Will an MBE "for services to medicine" be enough or would you prefer an OBE ? I just can't seem to remember the pecking order.

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  • no ,1.14 i think he will deserve the same accolade as lord darzi..and the same glowing regard from colleagues currently under desperate pressure.
    another great pioneer in the making................................

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  • Ivan Benett

    I am happy to respond to individual questions from named people, please email me at ivan.benett@nhs.net.
    On a few general points, the evaluation is by no means complete and I have said since the start that we need at least 12 months to get a feel for full impact. The reporter asked for early data, and that's what she was given. Neither would I ever claim causality between extended hours and reduced A&E activity since this pilot was not set up in a way that can easily show this 'beyond reasonable doubt'. I think we will be able to show 'on the balance of probability' that extending hours of service has made a change for the better.
    What I can say is that compared to last year at the same time people registered with Central Manchester practices are attending less at A&E for 'Primary Care ' type issues. So Central Manchester practices WITHIN the whole system are doing something different from most of the rest of the country.
    Further impact will be achieved once NHS 111, A&E and OOHs can directly book in to the extended hours, which we are working on right now.
    We will never convince those who are idiologically opposed to providing a service for our patients, some of whom chose to comment anonymously in these columns. What I'm interested in is investing in Primary Care to deliver a service our patients pay for and deserve. Those who want investment in Primary Care are getting just that in our extended hours service. No-one has to work more if they don't want to. Patients see a doctor with access to their records. Everyone is a winner

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  • Unlike Dr Bennett I do not believe many GP's are ideologically opposed to the concept of better access.
    Indeed I congratulate my colleagues who continue to soldier on providing OOH care.
    I do believe that those of us who work full time at the coal face are all too aware of the constraints of limited resources and the 'tough choices' in allocation of them.
    The short term money provided to set up these pilot schemes is surely a poisoned chalice the contents of which have foolishly been supped.
    Next year the poison will take effect after the contract negotiations.
    Those few remaining GP's who remain will be expected to provide 7 day access without new money ie for free.
    At least there was one hint in the article that the Government may have some awareness of the recruitment crisis -will that alter their negotiating tactics?
    I won't hold my breath.

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  • You talk about savings for CCGs but will this be passed on to practices once the next Government withdraws the initial trial funding? Just stop and think what you are committing your colleagues to.With what democratic mandate do you choose to represent your hard-pressed and impoverished colleagues?

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  • Vinci Ho

    Self funding ?
    Debatable:
    The money saved from reduced admission to A/E is to fund this service as there will be no more '50 millions' after 12 months.
    In real terms, the amount of money will be cut from the core funding of our A/E colleagues . A good way of further dividing us between primary and secondary care ??
    Then if this money is spent on investing currently existing out of hour GP service , can we argue that same 'good' result can be achieved?
    A horse is a horse, a deer is a deer. One cannot confuse people by pointing to a deer and call it a horse . Chinese old saying .......

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  • Vinci Ho

    Well , Sir Alex Ferguson thought he was that right about David Moyes.........

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  • If GPs are open for longer it it is obvious that fewer people will turn up at A/E.It is no more than duplication of OOH services.But then do we know how many of those will be re-attending to see their usual GP?The only way this will be cost effective is if it is cheaper for the patient to see a GP during extended hours than an A/E doctor.However i don't think any of this really matters as extended access is seen as a significant vote winner and will be pushed through regardless

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  • Unfortunately the government is not interested in investing in primary care, they are interested in funding schemes like these. Where funding is used to prove a case for access, with spurious claims for success, which will then become a point of contention that if GPs do not provide this they are letting their patients down and not avoiding A&E attendances as a professional failure! I'm sure at the end of this study you will be able to compare the number of new appointments and the reduction of A&E attendances and the cost of each attendance at practice compared to the reduction of relatively low cost A&E attendances, which you would have to presume as they were 'unneccessary' led to no admissions, and that this has therefore affected nothing costwise apart from minimal savings at the trust end (for which they will save money by not employing A&E doctors as GPs are able to do the work) and not significantly reducing the taxpayers costs. With no empirical figures this would seem like a, neccesarily massive, increase in funding to GPs (that this government is ideologically against wider) for somewhat limited returns in terms of spend in secondary A&E care. I think the public (and the government) would want more investment in acute services than money for access 24/7 into GPs pockets to provide something they could provide anyway without huge investment. The case may be put simpler that this could easily be achieved with changes in Practice opening hours rather than an investment in 24/7 primary care, as everything mentioned in this article could be easily acheived in that way! please be aware of how any 'evidence' you produce may be used, and define very clearly causality, along with the role and level of funding to avoid the results being open to use spuriously for other agendas. I suggest this information may be collected for other purposes, as can be seen from the generalisations inferred in the article above, and maybe used for the crafting of a stick not the cultivation of a carrot.

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  • Believe nothing until you see the ED attendance figures. From what is already in the public domain, on the BBC tracker, Central Manchester NHS Trust missed its four hour wait targets and there was no downward trend in the number of attendances (week 20 attendance similar to the average at 2881). No sign of this initiative benefitting ED

    Therefore, just like with 24 hour Tescos, this simply created demand for appointments that otherwise would not have been made.

    Simply asking people if they would have gone someone else isn't science,, it's hearsay., When we are talking about large sums of public money, we need honest, unbiased appraisals, preferably from an independent group. Not this propaganda

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  • Carl Hutson

    Please define 'unnecessary A+E attendance ' and is this a definition from medics or patients?
    Audits of past attendances at our local A+E have shown very low numbers of what I would define as unnecessary.

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  • The truth is this initiative had no impact at all on the crude daily ED attendance rate.

    It therefore just pandered to Norman and his colleagues who want their own GP at their beck and call 24/7.

    Ivan says 'we estimate this led to a 27% reduction in primary care ED visits', whatever those weasel words mean. Why doesn't he publish the actual figures?

    I think we can all guess the answer to that one...

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  • RESULTS ARE AS EXPECTED. no one want to go to a and e if alternative is available. fund it and all parties will be happy.

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  • When we increased our daily appointments and started ext surgery several years ago, we all noticed reduction in day time access demands. Even monday was ok.

    This lasted for a couple of months then within a year the access demand was back up to normal, except we were doing longer surgeries and evening surgeries.

    I hope this doen't happen in Manchester and over burden the already over worked GPs there. I feel for them.

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  • Access to healthcare are like road building for traffic,The more roads you build the more they fill with traffic.The only thing that reduced traffic on the roads is when the cost of fuel went up.This will have to happen in healthcare but in the NHS system there is no cost to the user and supply will always be filled and eventually saturated.The only thing that is giving at the moment is the workforce and once this happens it will be catastophic and stystemic failure will follow(if it is not already).

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  • Dr Mustapha Tahir

    I never expected any other results to be published besides this one!

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  • This guy is called a leader or pioneer for what !!! Leading us to an early grave !. Give me a break for Christ sake.

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  • Took Early Retirement

    "We will never convince those who are idiologically opposed to providing a service for our patients..."

    I think that is very unfair. I have provided a service for 29 years now. In recent times, with the advent of surveys, it seemed that the MORE we provided, the less satisfied people were. This was noted by others at Hampshire LMC, when I was still a member.

    I am ideologically opposed to being told to constantly do more, with less, however it is dressed up. Were the GPs working these unsocial hours paid more than those working in-hours? I sincerely hope so.

    It was quite clear, when we had 3 WiCs in Southampton, that they did nothing to reduce ED attendance- they just seemed to produce another tier of patients.

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  • If we decided to not fund A+E to treat minor ailments we would not need 7 day working.

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  • Thank to our pioneers for holding the nails as NHSE hammer them steadfast into our professional coffin.

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  • Just Your Average Joe

    'If we decided to not fund A+E to treat minor ailments we would not need 7 day working.'

    Simple - cost effective to implement (FREE), and would make hospitals send back patients to where they belong - Day time GP clinics.

    Old A&E type trauma centres downgraded to minor injury units no longer take MI and Major trauma - they go to the appropriate place instead.

    Nurse led clinic in walk in don't see under 2's, so they are directed to the correct place.

    Use the money to fund better access 'IN Hours', rather than rob Peter to pay Jeremy Hunt.

    I notice that the MP's felt no choice but to accept the results of their independent pay review, but over-ruled the similar advice for GP's.

    Still don't understand how JH is still in a ministerial position of trust after the Murdoch scandal!

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  • Just Your Average Joe

    David Fox | Salaried GP | 25 April 2014 11:59pm

    If we decided to not fund A+E to treat minor ailments we would not need 7 day working.

    Apologises - credit to Dr Fox for the original point was intended.

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  • Took Early Retirement

    Sad truth is that in my experience, virtually no "initiative" achieves what it is hoped it will. it sometimes achieves the reverse- for example, the Darzi Centres. MASSIVE costs in the case of Southampton and STILL getting c £250 per patient per year in funding. (In the first year it was £1000 per pat- I kid you not; FOIA enquiry each year by me!)

    Also, after a year or so of pilots, the money dries up and we go back to square one whatever- usually.

    Very few GP practices can take part as leaders in things like this, since if it goes TU or the money stops, the partners become liable for redundancy payments. NHS trusts however, are much bigger and can take the hit.

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  • Strike. Close the doors. Done. This story is so rude, lost for word

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  • I think we should really lobby for separate contract before 7 days working comes in to force with out any investment in primary care….wake up these are the of bogus pilots which will be used to support and enforce on all of us with no increase in funding.

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  • Strike,only come back if a fee for service is arranged as per australia. Simple. Those gp's that don't strike - idiots and no doubt will be the ones looking after their pension. If no one at the GPC has the cahoonies to do this - set up another union. That's what I suggest! (ex-gp partner, enjoying oz! )

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  • Hats off to them for trying. However, opening GP surgeries for 7 days a week, even 24/7 is like sticking a plaster on a gaping wound....which really needs stitches. Demand will continually outstrip supply in the UK.

    Lets stop kidding ourselves - the reality is that the current UK Health system funded by tax-payers subject to political interference, a hierarchy lacking transparency, credibility and focus, mixed with poor forward-planning needs a total overhaul....its time to start discussing alternative funding options for healthcare in the UK. End of

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  • Dr Bennett refers to a service "our patients pay for and deserve"!
    They don't pay for it, they mostly get it cheap, and the highest users/abusers contribute the least through taxation!
    They should be made to pay for anything beyond the basics, like A&E attendances, defaulting on appts in primary and secondary care, and especially life-style conditions!

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  • Ivan 's brother Gordon says it all really.

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  • The commissars continue in the colectivization of primary care.

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  • @8.52 LOL
    Or indeed his distant half cousin Peter Bonetti, late replacement for the great Gordon Banks left stricken by Montezuma's revenge at Mexico 70.
    2-0 and looking comfortable against the Germans.
    A stroll through midfield by the imperious Beckenbauer, a looping header by Uwe Seeler and finished off by der Bomber, Gerd Muller, after panic in the penalty area.
    2-3 and we are out!

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  • Three years ago when I was mad enough to join my local CCG Board I suggested that A and E departments should be paid for seeing minor injuries at the same rate as GPs were paid and that I did not understand why a review of a sprain was paid at a higher rate in a and e compared to GPs. I immediately got told off for daring to suggest such a thing 2 others GPs on my board then immediately disciplined me and I was told that I could not be trusted to work closely with the local DGH managers as they were "upset" by my remarks. This year our CCG board is making us code all minor injuries to see if we deserve any payment at all for seeing minor injuries. So instead of questioning the payments hospitals receive it's our payments that are in doubt which are tiny compared to the hospitals. This scheme like many others are successful because GPs are able to get things done cheaper and unfortunately many of our CCG colleagues are in cahoots with hospitals managers in order to save money by exploiting GPs goodwill and dumping more and more stuff on our doorstep. This project is yet another example of GPs being used by the system. It's time to say no. I feel really sorry for Manchester GPs. Una Coales we cannot wait for your motion and to be able to say to our CCG "leaders", the public and the government that we have had enough and wish to resign from the NHS.

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  • Ivan Bennett is a total Jeremy

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  • Una Coales

    @10:02 pm yes I am hearing that hospitals are charging CCGs for extra lists and paying consultants up to £200/h to see a list of up to 8 (fewer with DNAs) patients for follow ups. We GPs have also had to take the savings we have made and hand it back to hospitals who seem to always be in the red.

    Clearly we must negotiate for a contract that pays per service/consultation like the tariff hospitals and dentists charge.

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  • Support Una's motion...resign from the NHS

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  • 02 May 2014 7:41pm

    agree!

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  • Ban the drunks form A&E that would be a good start!

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