ICBs planning same-day hubs ‘do not care about GPs’, says BMA leader

The BMA does not support controversial plans for same-day hubs, as they are ‘all about’ reducing A&E attendances rather than improving GP care. 

England’s GP Committee deputy chair Dr Samira Anane also said that separating on-the-day cases from more long-term, chronic cases results in a ‘fragmentation’ of care and is ‘not safe practice’.

And she criticised North West London’s now-shelved plans to effectively mandate same-day hubs. 

According to Dr Anane, who spoke at Pulse LIVE last month, NWL ICB leaders ‘don’t care about GPs’, and there is an ‘obsession’ with the idea that patients go to A&E because they struggle to get a GP appointment. 

North West London’s plans were heavily criticised by GPs and patients alike, leading to a concession from the ICB that the hubs will not be mandated as part of the enhanced services single offer in this financial year.

But GPs in the area are still expected to come up with a plan to improve same-day access, with the hubs being used as a potential model. 

And the ICB CEO recently suggested that removing on-the-day care from GPs in this way is a ‘national imperative’, based on the 2022 Fuller stocktake, which has been accepted by NHS England.

Other areas of England are exploring similar models – Pulse recently revealed an ICB’s plan to overhaul its GP model so that patients are triaged by 111 call handlers and seen in a ‘neighbourhood hub’. 

Responding to a question about hubs at her Pulse Live talk, Dr Anane said: ‘The problem with hubs is that it’s a fragmentation of patient care. 

‘When someone rings you up with a broken nail, potentially, they might have wanted to talk about something else. How do you know? We know our patients. So the reception will say “oh so and so has called five times”. Okay, right, something is going on.

‘If it’s going to a hub, you don’t have that knowledge. So it’s not good for the patient, but it’s also not safe practice. That part of the picture is blinded to us.’

She also questioned the evidence in favour of implementing same-day hubs: ‘We know we have the respiratory hubs for Covid etc, but splitting acute, on-the-day from chronic – who says that makes sense? 

‘Holistic continuity of care is the relationship of the patient and practice…that is the evidence base. There’s no evidence base [for hubs].’

Speaking specifically about the plans in NWL, Dr Anane said: ‘It’s all about ED. They don’t care about GPs, they don’t care about patient experience. It’s about the A&E attendances which cost £170 versus a GP appointment, and there is an obsession that [patients] are going to hospital because they can’t get a GP appointment.’

According to the GPCE deputy chair, Manchester University has found that A&E attendances are ‘nothing to do with that’ and that patients will still go to hospital even when offered a GP appointment.

Last year, researchers at Manchester University linked a high turnover of GPs to more A&E attendances by patients, highlighting the importance of continuity of care.

Dr Anane argued that ICBs looking to implement hubs are focused on improving the performance of hospital emergency departments rather than general practice.

‘We wouldn’t support these hubs at the moment, because the [key performance indicators] KPIs are not for general practice,’ she added. 

In response to Dr Anane’s comments, NWL ICB told Pulse its proposals for same-day access are ‘a direct response’ to how patients describe their experience.

‘The ICB has spoken to hundreds of community groups and residents over the last 18 months about what matters to them. By far the biggest issue that they consistently raised with us was difficulty getting a GP appointment,’ a spokesperson said.

They added: ‘We know our GPs are working harder than ever – we are offering 1.4 million appointments across North West London every month – prior to the pandemic, that figure was 900,000.

‘But it is clear from what residents tell us about their experience that many people’s needs are not being met.  Our same day access proposal – which was co-designed with 10 primary care networks – is an attempt to address that and improve access to primary care.’

When asked about NHS England’s views on the same-day hub model earlier this year, primary care director Dr Amanda Doyle said she wants to ‘step back’ and let local systems get on with testing their proposals.

The clinical director for the Foundry PCN Lewes, which was highlighted by the Fuller stocktake for its success in managing urgent demand, told Pulse that same-day access hubs should be rolled out ‘in a mandatory way’.