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ICB shelves same-day hub plans due to GP and patient backlash

ICB shelves same-day hub plans due to GP and patient backlash

Exclusive Same-day access hubs will not be mandated in North West London as the ICB bows to pressure from GPs and patients.

In a letter to GP teams, seen by Pulse, the ICB said that their controversial same-day access programme ‘will not form part of the single offer for enhanced services for 2024/25’.

Instead, ICB leaders said they want to work with PCNs ‘to consider how access can be improved’ and that they do not have a ‘presumption’ about a ‘particular model’ all PCNs should adopt.

They are now aiming for a new model to be implemented from April next year instead.

Last month, Pulse revealed that NWL planned to effectively mandate the use of same-day access hubs by introducing the requirement as part of its single offer.

The hub model aimed to ‘deliver a single point of triage for same-day, low complexity’ demand for all 2.1 million residents within the integrated care system, leaving GP practices with only longer-term, ‘complex’ care.

But London GP leaders, as well as patients, raised ‘immense concern’ with the plans, including patient safety, quality of care, and logistics.

In response to these concerns, the ICB confirmed yesterday that it has ‘adjusted’ the same-day hub programme, and that it wants to ‘move forward collectively’ to address both patient access issues and GP pressures.

The letter said: ‘The Same Day Access programme will not form part of the single offer for enhanced services for 2024/25.

‘We will develop a robust plan to utilise the £6.6m that NW London ICB has allocated in 2024/25 for improving access to primary care. As with all public funds, the ICB is required to ensure there is clear accountability for this resource.’

Going forward, local commissioners want to ‘consider different ways of working’ and ‘collaborate with patient groups’ to look in particular at access that addresses inequalities, such as for vulnerable patients and those who are ‘digitally excluded’.

They went on to say: ‘The ICB is not approaching this with the presumption that there is a particular model PCNs across North West London should adopt, nor that all PCNs should adopt the same model.

‘In particular, the ICB will support practices and PCNs to prioritise continuity of care for those residents that most value it and where this is essential for high quality clinical care.’

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The letter suggested that health officials still want to ‘maximise access’ by taking advantage of ‘scale’, but that any new ways of working will be worked through and embedded ‘within the single offer contract in 2025/26’.

It also admitted that the ICB’s previous communications with GP teams had ‘spurred significant concerns’.

The ICB has said today that its proposals were ‘misinterpreted’ and but that access is still a top issue for primary care.

A spokesperson said: ‘NHS North West London remains committed to improving access to primary care. This is the number one issue residents consistently raise with us, as do practices concerned about the growing pressures they are under.

‘Having listened to feedback from our patient groups, GPs and PCNs, we recognise that our proposals to increase access have been misinterpreted. It is for this reason that we have decided to allow more time to work with PCNs, GPs and patients to clarify our plans.’

When concerns were first raised by Londonwide LMCs, local commissioners maintained that the programme would go ahead but agreed to roll it out in a ‘phased’ approach.

Almost 9,000 patients in North West London had called for an ‘immediate pause’ on the ICB’s same-day hub plans in a petition which started less than a week ago.

This was part of a patient campaign to oppose the ‘drastic new changes’, which the petition said were ‘being forced’ on all GP practices in the area despite the ICB having failed to consult with residents.

Last week, Londonwide LMCs published an analysis outlining their main concerns and how the ICB had attempted to address them.

This included whether sufficient public engagement had taken place. According to the document, the ICB claimed to to have consulted the public but was yet to share outcomes.

Other concerns included the impact on continuity of care from the plans, with the ICB having told the LMC that PCNs who trialled their model have managed to ‘increase capacity at practice level to those who will benefit from continuity of care the most’. 

But the LMCs pointed out that there has been no ‘explanation of the detail behind this’ and no analysis of outcomes from these pilot PCNs. 

Last week, asked about the same-day access proposals in NWL, NHS England’s national director for primary care said she wants to ‘step back’ and let local systems test out their own plans. 

Pulse has reported on other areas implementing similar models, including in Cornwall where retired GPs will staff hubs to ease on-the-day demand, and Oxfordshire where ‘non-complex’ patients will be dealt with at same-day hubs.



Please note, only GPs are permitted to add comments to articles

Mr Marvellous 6 March, 2024 1:12 pm

“we hugely value their vital work..”

2% doesn’t seem to be “hugely” valuing anything.

Centreground Centreground 6 March, 2024 1:16 pm

The clear reality is that significant numbers of bungling senior managers/GPs sitting on ICB/ICS/NHSE /previous CCG boards now supplemented by PCN Clinical Directors are simply not fit for purpose in my opinion.
This is evidenced by the devastating NHS decline they have overseen over decades and continue to oversee in the NHS with many of the same manager names appearing as they hop from one board to another leaving chaos in their wake.
We have come to expect ridiculous management oversight in the NHS led by an inept and failing NHSE with a history of record breaking level of legendary incompetence well informed to us by Pulse with the expectation of an article further informing a U Turn once these absurd and irrational decisions are overturned by board members with no ability in my view to foresee the obvious and the pandemonium they generate across the entire country.
This is exacerbated by a useless and ineffective RCGP in my view whose main role is collection of fees for no real benefit and undertaking preparations for some of its members for visits to the palace for award collection.
This incompetence will cease in my opinion only when this collection of individuals cease to circulate in these board positions although this assembly of directionless ineffectual individuals has now grown into a self-proliferating army of hopeless leaders and will be difficult to shift.
At least the currently BMA has a clear path and we shall wait and see.

Simon Gilbert 6 March, 2024 1:24 pm

A lot of GP care is neither urgent nor routine, rather it is Emergent that requires time and serial consultations with good access and continuity to resolve or diagnose. Central planners don’t understand this.

Liam Topham 6 March, 2024 1:35 pm

fully agree Simon – also “the role of the physician is to keep the patient occupied whilst nature effects the cure” – I don’t think central planners understand this either – even when they are being advised by KPMG

David Jarvis 6 March, 2024 1:36 pm

Want to improve access just give GP practices the funding and bugger off. Give us the funding wasted on your wages too. See how well we do. GP’s are good at running things. Look at COVID jabs I believe 75% were delivered by primary care for less than 75% of the money spent.

So the bird flew away 6 March, 2024 4:29 pm

Hopefully the first of many u-turns. Next, expansion of ARRS roles to include GPs?

John Charlton 6 March, 2024 9:05 pm

There is a very useful description. Same clowns, different circus. Can be reversed. As many point out the bungling inept management of the present circus remains the same.

Bettina Schoenberger 7 March, 2024 7:38 am

So many arguments against. As mentioned elsewhere huge potential to waste, pander to the wrong crowd, set wrong indications, multiply investigations, overlook complexity, miss vital connections and contraindications, duplicate appointments and perpetuate and reinforce wrong behaviour. Have I mentioned wrong money on wrong management by wrong people on health boards?

Darren Tymens 7 March, 2024 11:34 am

(I think we should offer a shout out to Londonwide LMCs who I suspect had a significant impact here, quietly and behind the scenes)