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CCGs tackle winter pressures with extra GP appointments and remote monitoring

Commissioners are putting in place a range of measures to help general practice deal with winter pressures over the coming months, including funding extra GP appointments and introducing schemes that involve remote monitoring of care home patients.

Some CCGs in England are instructing practices to stop routine appointments over the Christmas period, while in another region commissioners pointed to the opening of an urgent treatment service in its primary care centre at the local hospital (see box).

But CCGs have not been provided with additional funding for their proposals. At a national level, NHS England has only announced its £10m fund to cover GPs’ extra indemnity costs associated with any extra shifts worked outside of core hours this winter.

And GPs have warned the plans will fall short of what is required to deal with any surges in demand over the coming months.

Meanwhile some commissioners have so far not put any plans in place to deal with extra demand in the colder months, according to GPs.

In a recent survey by Pulse, carried out in November, more than a quarter (28%) of the 558 UK GPs responding said local proposals to help general practice this winter were either non-existent or had still yet to be revealed.

Dr Anu Rao, vice-chair of Leicester, Leicestershire and Rutland LMC, said many commissioners wrongly believed extended access appointments at practices – during weekends or after 6.30pm in the week – would solve the problems.

She said: ‘CCGs hope the extended access scheme will help winter pressures – but we have massive problems recruiting GPs to work in the scheme.’

Dr Rao said the high demand experienced by A&E departments over the summer and autumn in addition to delays to flu vaccination deliveries meant there was an even greater risk of pressures being felt by GPs this winter.

‘If we were worried last year, we are three times more likely to be worried this year. In the summer our A&E appointments were up and they weren’t able to cope. The bed situation isn’t great in hospitals. Discharges are done early on so there is high risk and high prevalence of readmission.

‘We need to be highly concerned this year compared with any other – especially with the flu campaign being a bit out of control.’

Dr Peter Scott, Birmingham GP and chair of Solihull LMC, also warned the delays to practices receiving flu vaccine had increased the risk from any potential influenza outbreak.

‘It’s fortunate we haven’t had an outbreak or epidemic. Logistical difficulties have meant rollout has been slow. Had there been an outbreak we would have been very much at risk,’ he said.

Dr Richard Vautrey, BMA GP Committee chair, said: ‘Demand remains high all year-long, meaning patients face frustratingly long waits for appointments, and GPs see no respite for their workloads in what were traditionally quieter months.

‘Realistically there is little to no spare capacity to respond to the upsurge in demand that winter could bring.

‘Unlike hospitals, which must make difficult decisions to manage extra demand during the winter, GPs don’t have the option of cancelling operations or other “routine’ work” – as most of what we do simply must continue.’

An NHS England spokesperson said: ’This year the Government allocated £240 million winter funds to local authority social services, and it is important that local councils now work closely with hospitals and GP-led CCGs to ensure patients get the home care packages and care home support they need.

’An extra £10 million is also being given over winter to pay GPs indemnity costs to help additional out of hours appointments and NHS 111 capacity.’

What are commissioners doing to help GP practices?

NHS Milton Keynes CCG: requesting that practices only offer urgent, on-the-day appointments between Christmas and New Year.

NHS Rotherham CCG: implementing a new pilot for care homes and GP practices, which enables patient needs to be monitored remotely, reducing the need for a GP visit.

NHS Herts Valleys CCG: providing an extra £1.10 per weighted patient to practices in the region to offer appointments after school hours, specifically for children, and care home visits in the morning.

NHS Wigan Borough CCG: funding an additional 16,000 appointments between November and March, while also opening an urgent treatment service in its primary care centre at the local hospital.

NHS Doncaster CCG: ensuring an extra 640 GP appointments are available each week, through extending access to surgeries. Offering a Choose Well app, offering signposting to services.

Scottish Government: has provided £10m of winter funding to NHS health boards, although it is unclear how much of this has been spent on general practice.

Welsh Government: has allocated £4m to ease winter pressures and part of this funding is to support two pilot schemes that are looking at extending GP access into evenings and weekends.

Northern Ireland Government: investing additional £2.27m to cover 7,000 extra surgeries to help practices offer same-day urgent appointments, remain open at lunch time and ensure there are no half-day closures following the Christmas and New Year holidays.

Source: Pulse media request