NHS England to ‘step back’ and let ICBs test same-day access at scale

NHS England’s primary care director has said she wants to ‘step back’ and let local systems get on with proposals to overhaul same-day GP access.

Speaking at the NHS Confederation primary care conference yesterday, Dr Amanda Doyle said she does not have ‘that much of a problem’ with systems filtering out minor issues like ingrown toenails to be dealt with ‘at scale’.

However, she said she would be ‘more nervous’ about systems where everybody is dealt with at scale and it becomes hard to offer continuity of care properly.

In North West London, GPs and patients have criticised their ICB’s plans to effectively mandate the use of same-day access hubs via its enhanced services single offer.

The proposed model of care in North West London has built on the 2022 Fuller Stocktake, which was accepted in full by NHS England and recommended that same-day appointments are dealt with by ‘single, urgent care teams’ across larger populations.

At the conference, NHS Confederation chief executive Matthew Taylor asked Dr Doyle how to balance continuity of care with access, and specifically whether other systems should be pushing ahead with the Fuller agenda, citing the ‘radical’ plans in NWL.

Dr Doyle told attendees she finds it ‘really hard to resist ploughing in and interfering with stuff’ but that she wants to allow systems to test out new models of care.

She said: ‘I really want to give local PCNs, but also systems, the space to try solutions and see if they work. And I am conscious that two or three systems are doing this sort of thing.

‘What they’re all doing is slightly different. So it’s actually quite a good opportunity to see what works. The test will be whether patients like it.’

On whether she agrees with separating on-the-day care and longer-term care, the primary care director suggested she was supportive of proposed plans.

‘Continuity is really important, but I haven’t got that much of a problem with places that are saying “we’ll just filter out the ingrowing toenails and the quick, very one-off things, and support practices to get them seen in an organised manner at scale”,’ she said.

But Dr Doyle suggested that plans to offer large cohorts of patients care at scale would make her ‘more nervous’.

‘If it becomes something that said everybody’s being dealt with at a scale, where it becomes hard to offer continuity properly, then that would become apparent very quickly, and then that would be something that would make me more nervous.’

‘But I’m really keen to just step back and see how these things work. And the best test of how well they work will be how satisfied patients and practices are with what happens,’ she added.

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.

And the pioneer PCN for at-scale urgent care, highlighted in Fuller’s report, told Pulse that same-day access hubs should be rolled out across primary care ‘in a mandatory way’.