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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)

  • 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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