Same-day hubs are a ‘national imperative’, claims under fire ICB

The ICB at the heart of the row over same-day GP access hubs has said it won’t consult on the plans to remove on-the-day care from GPs because it is a ‘national imperative’.

NHS North West London CEO Rob Hurd told a council meeting last week that ‘some aspects’ of the controversial plans are ‘determined nationally’, meaning the ICB cannot conduct a ‘formal consultation’, despite GP and patient backlash. 

Earlier this month, the ICB was forced to shelve its plans for same-day access hubs, confirming they will no longer be effectively mandatory.

Pulse had previously revealed the proposals to effectively mandate the use of same-day hubs by introducing the requirement in its single local enhanced service offer, meaning practices will lose out on vital funding if they didn’t take part. 

The hub model, based out of PCNs or groups of PCNs, aimed to ‘deliver a single point of triage for same-day, low complexity’ demand for all 2.1 million residents within the integrated care system, leaving GP practices with only longer-term, ‘complex’ care.

But London GP leaders, as well as patients, raised ‘immense concern’ with the plans, including patient safety, quality of care, and the lack of public consultation and engagement.

At a meeting of NWL patient groups last month, attended by over 100 residents, London GP Dr Pamela Martin also criticised the lack of consultation. 

‘They’re rushing implementation. They’re seeking, it seems, a quick fix, even with the current proposed phasing. They haven’t respected the views of users – there hasn’t been a public consultation,’ she said. 

Last week, at the NWL joint health and overview scrutiny committee, councillors raised similar concerns, as well as calling out the lack of ‘co-production’ between the ICB and patients or staff.

Councillor Concia Albert asked the CEO: ‘Should we be ensuring […] what’s happening going forward is truly, truly built and embedded by patients and by GPs, by the public, and not led by the ICB?’

In response, Mr Hurd said that the ICB is trying to balance national policy with a local approach. 

‘The complexities for us are national processes that determine certain principles and how these things get rolled out.’ 

He went on to mention the ICB’s obligation to be guided by the 2022 Fuller stocktake, a landmark review which recommended that same-day appointments are dealt with by ‘single, urgent care teams’ across larger populations.

Mr Hurd said: ‘We’ve got some fantastic work from our primary care leaders trying to grapple with the highly complex change programme that sits between that national imperative and the Fuller report – that we do acknowledge our responsibilities to implement in line with that – and that there are things that we can improve, here and now today.’

He asserted that improving how GPs provide same-day access to services are ‘tweaks’ and ‘not a fundamental change’.

But he admitted there are some elements of the model that the ICB should ‘co-produce’ with staff and patients, such as concerns about ‘dumbing down’ primary care which had been raised by the committee.

‘We have to balance between allowing for continuous improvement of what is here and now, business as usual, […] and then co-produce within some of the fundamental principles I think you’re alluding to – the dumbing down, the triaging, the kind of principles that are at stake here which we’ve got to acknowledge – some of which are essentially embedded in national policy and in response to the workforce crisis that we face.’ 

When asked directly whether the ICB will commit to conducting a consultation, Mr Hurd referenced the fact that there is no public consultation on the national GP contract.

He said: ‘I don’t think there is a public consultation on that. That points to my point about some aspects of this are determined nationally; some aspects of this are what we at North West London would need to potentially consult on; and there are some aspects which are local.’

However, the ICB’s director of communications and engagement Rory Hegarty was more direct: ‘We don’t see it as needing a formal consultation on the basis that we’re trying to make happen at scale what’s already happening in most practices.’

A NWL ICB spokesperson told Pulse: ‘At this point, we are not putting forward any service change proposals that would require public consultation. The ICB has requested PCNs to work with patients and residents to develop proposals to improve access to primary care.

‘While we have proposed one approach through same day access hubs, we are also open to other ideas. We plan to work with patients and GPs in a spirit of co-design – it is difficult to see what question a formal public consultation would ask.’

Pulse has also approached NHS England for a response to Mr Hurd’s comments.

When asked about NWL last month, NHSE’s primary care director Dr Amanda Doyle said she wants to ‘step back’ and let local systems get on with proposals to overhaul same-day access.

The CEO’s failure to commit to a consultation prompted further concern from councillors at the scrutiny meeting.

Councillor Nick Denys said ‘some form of consultation should happen’ as this would help to ‘bring confidence’ in the proposals, where up until now there has been a ‘lack of confidence’.

He added: ‘I think the power to consult is based around whether there’s a substantial development or variation in how services are provided. 

‘Now for patients, I think this is a substantial development and variation, and certainly for GPs and PCNs, we’re hearing they think it is a substantial development and variation to what they’re being provided.’

Earlier in the meeting, Mr Hurd admitted that the way the ICB communicated its same-day access plans had been a ‘fundamental error’. 

ICB primary care leaders at the meeting sought to reassure the committee and public that there is no mandate from 1 April, and that the £6.6m intended for the access element of the enhanced services offer will stay in primary care.

They said this financial year will give GP practices and PCNs time to find out what their population needs in terms of access, but they could not yet commit to a start date for the programme. 

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.