By Ian Quinn
Half of all practice appointments will be handled by nurses under the latest set of cost-cutting plans revealed by NHS managers.
New proposals published this week by NHS London call for the proportion of appointments attended by nurses or nurse practitioners to increase from 33% to 50%.
The move, which it claims would save £290m, comes as NHS London issued a statement clarifying its plans to make savings from reducing GP appointment times, which have outraged GPs and their leaders.
Details of the skill mix shake-up were revealed as NHS London revealed possible locations for more than 100 polyclinics in London, which would see three in each London borough.
The SHA wants to shift 55% of outpatient appointments and 60% of A&E attendances into primary care, with GPs across the capital being moved into polyclinics - some of which may be privately-run - and working under so-called polysystems, each covering up to 80,000 patients.
The plans also include proposals for a 35% increase in the amount of time GPs spend face-to-face with patients, from 18.5 hours a week to 25 hours per week, a level NHS London says has already been achieved in Tower Hamlets.
The report says it aims to ‘adjust the skill mix with greater use of nurse practitioners, saving up to £290m,' and on the plans to slash appointment times it says it will be ‘moving to best in class appointment length.'
Meanwhile in a letter to Pulse, NHS London chiefs sought to explain their plans to make savings from cuts in GP appointment times, which have attracted fury from GPs across the country.
Dr Daniel Burrow, a GP in Darlington, told Pulse: ‘Indicator PE1 of QOF stated that appointments with patients must not be less than 10 minutes. Surely NHS London cannot legally override a national contractual agreement?'
But Sam Higginson, assistant director of strategy at NHS London, said: 'Our strategy is underpinned by the need to improve quality and access to care by shifting activity out of the acute sector into polyclinics.'
'As part of this strategy, we intend to treat a far greater proportion of people with long term conditions currently treated in hospitals in the community. Our analysis is based upon the premise that we can standardise the average length of appointment times for example by introducing greater use of new channels of communication such as greater use of telephone and email consultations.'
'Our London level modelling was based upon current appointment lengths of 10 to 15 minutes. We then assumed appointment lengths would increase to on average 15 minutes because of the greater number of consultations with people with long terms conditions. However, through standardisation and moving towards best practice our modelling brought this down to 10 minutes on average. This analysis was at London level. Commissioners are now developing their specific plans.'NHS London plans for nurses to deal with half of all appointments