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

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’.



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

Douglas Callow 29 February, 2024 12:38 pm

how big or her to duck the flack that will follow

Centreground Centreground 29 February, 2024 1:03 pm

When the leadership steps back there is no leadership!

David Church 29 February, 2024 2:44 pm

Agree with those above. Isn’t she paid extra to provide ‘leadership’, not just to make it compulsory and then distance herself from carrying the can when it predictably goes wrong and damages patients?
It seems a rather cowardly move to me.
Or was she actually really paid to ensure breakdown of the caring NHS system.

Douglas Callow 29 February, 2024 2:50 pm

DC yes paid with an OBE

Turn out The Lights 29 February, 2024 3:46 pm

Quite Pathetic really.

Liquorice Root- Bitter and Twisted. 29 February, 2024 5:15 pm

Which will improve continuity of care.

Darren Tymens 29 February, 2024 10:37 pm

She is obviously keen to distance herself from whichever car crash ensues. Either way, significant damage will have been done to the profession and to the NHS. I hope she understands what this is doing to her reputation within her chosen profession. I note that RCGPs response to the current existential threats (discussed elsewhere) is as weak and neutral as usual. They remain on ‘beige alert’ whilst the profession goes down the pan.

On another, lighter note: I think we should have a caption competition for the image at the top of the article.

First time I saw it I wondered if she thought she was eating an invisible sandwich.

Alternatives include ‘How big a lie am I telling?’ and ‘How big a gong am I hoping to receive?’

So the bird flew away 29 February, 2024 11:36 pm

Cat’s cradle world champion forgets to bring her string
Or she’s saying “next year the NHS budget is going to be this big”.

David Ball 1 March, 2024 8:49 am

It looks like we need to put all efforts into setting up dedicated, rapid-access ingrowing toe-nail clinics – as that seems to be the main concern and apparently the main thing that we deal with!

Liam Topham 1 March, 2024 1:22 pm

for the caption competition; “I got this close to a patient the other day”

Sam Macphie 7 March, 2024 1:50 am

Dr Mandy Doyle appears to be saying ( in the above photo ) “I hold up my hands; it’s a dumb deal; and it is just postponed.”