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GPs in second area to stop same-day care in bid to relieve workload

GPs in second area to stop same-day care in bid to relieve workload

Same-day access hubs to treat ‘non-complex’ patients outside GP practices are set to become standard in another area, according to primary care strategy consultation papers.

Buckinghamshire, Oxfordshire and Berkshire West (BOB) ICB has asked for public feedback on its strategy, which sets a priority to ‘expand at-scale triage and navigation to appropriately direct same-day non-complex need’. 

The model is very similar to plans in North West London, where the hubs will be effectively mandated as part of an enhanced services single offer.

BOB ICB expect its plan will ‘release capacity in general practice to focus on those with more complex needs’ and address the issue of access, which is the population’s ‘biggest concern’.

Its primary care strategy said around 70% of the population’s health need is ‘low complexity’ and this makes up approximately 50% of GP activity. 

It suggests that hubs could deal with issues like urinary tract infections, where ‘speed of access is generally more important than continuity of care’. 

The proposed model of care will mean that patients who select ‘same day’ care when contacting their GP practice will be triaged by staff at a same-day access hub, and either seen at the hub or redirected back to their practice or on to other services. 

Staffing for the hubs will be provided by local practices and the wider system, including a multidisciplinary team made up of GPs and ARRS roles. 

BOB ICB’s strategy does not reference a funding offer attached to the hub proposal, and there is no mention of GP practices being obliged to take part. 

However, in its timeline for delivering on the same-day access priority, the ICB states an expectation that between March and August this year three sites are set up in each Place. And by August 2025, BOB aims to have ‘up to nine sites in each Place’. 

A ‘site’ is defined as a PCN or a group of PCNs working together at scale, and should be organised according to local needs. 

The strategy said: ‘This way of working is emerging in parts of BOB and is in line with national direction of travel around at-scale working. 

‘Working at scale (e.g. through same-day access hubs) can help to improve access as it involves a multidisciplinary way of working, utilising a varied workforce to deliver a wide range of services e.g. a hub could have pharmacists, physician associates, dentists and specialist nurses. This can help manage demand more effectively in a local area.’

These plans, along with similar proposals in NWL and in Cornwall, build on the 2022 Fuller stocktake, a landmark review on how to integrate primary care with other NHS services which recommended that urgent same-day appointments should be dealt with by ‘single, urgent care teams’ across larger populations rather than the patient’s own GP practice.

But, earlier this week, Pulse reported ‘immense concern’ with the proposed model among NWL GPs, particularly around the threat to continuity of care. 

BOB ICB did not clarify whether GP practices will be obliged to take part in the same-day access hub model, but suggested that a change is needed to make primary care more sustainable.

An ICB spokesperson said: ‘BOB ICB is currently undertaking a prolonged period of engagement with a broad range of stakeholders regarding all aspects of its draft Primary Care Strategy.

‘Same day non-urgent access is one component of the draft strategy being considered and we are committed to work with colleagues to shape this. The pressures on our workforce in primary care are unsustainable and we want to ensure our population have an improved access experience. This will necessitate a change in how care is delivered.’

A survey collecting feedback on the strategy will be open until the end of this month. 



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

Nick Mann 16 February, 2024 2:21 pm

Unsustainable because GPs are delibately barred from ARRS.
Talk about moving into silos- no reference to intersectional nature of medical care, it’s just painting by numbers.
How can you pretend to be advocating ‘better’ care when the whole bedrock of good/excellent care is built on the fabric of continuity? Families and episodes of care are integral.
The segregation of acute, urgent and emergency care was ordained long before such “unsustainable” pressure was applied.
This is about the morphing of medical care and a dumbing-down of service for the convenience and ultimately the benefit of future providers.
You could ask KPMG but, oh, “commercial sensitivity”.

David Jarvis 16 February, 2024 2:52 pm

Urgent care actually being the fun easy bit. Why when they look at reducing GP workload do they always look at taking over the easy bit. What about a chronic pain service or an acute mental health service or even just a functioning hospital admin service rather than GP to chase. We already have ARRS staff doing easy stuff meaning my surgeries are wall to wall chronic , incurable and very complex stuff most of which were manged in hospital when I started. Case mix I would argue is the best way to reduce burnout. It is just another break up to wreck the NHS.

David Jarvis 16 February, 2024 2:54 pm

They stopped passport signing to help us. It was easy work and we could charge for it. And not that many either. So wow that really helped.

Nicola Bignell 16 February, 2024 4:45 pm

Completely Agree DJ. Also we deal with this stuff much more quickly as we know the patients.

Robert James Andrew Mackenzie Koefman 16 February, 2024 4:46 pm

If only they could understand that if they gave practices the funding they give all these blue sky ideas we would employ and sort it out ourselves. the more access points you create the more demand you get.Not a solution just stoking the fire for unsustainable healthcare.

Michael Green 16 February, 2024 5:09 pm

There’s no evidence of benefit from seeing untrained “practitioners”, or moving demand around from practices to hubs or spokes or places or neighbourhoods, or for wrecking continuity.

But Fuller said it, so it must be true. It’s in line with the Fuller principles and the Fuller stocktake. The latest entry in the NHS England BS Bingo. Bow down 🙇

Not on your Nelly 16 February, 2024 5:45 pm

Did anyone else see Dentist in the list? Will the dentist be seeing acute medical problems? or are noctors now going to act as dentist due to lack of primary care doctors?

Samir Shah 17 February, 2024 3:43 am

More and more people will end up with delayed diagnoses which leads to having worse longterm outcomes because of strategies like this. With same day and unscheduled problems, it’s foolish to call it easy or complex care. With serious and longterm problems, the symptoms can be the same as those that the ICB consider ‘ low complexity’ initially.

David Church 17 February, 2024 10:58 am

Any fully-trained GP can tell you that this crisis-driven knee-jerk reaction is actually going to disjoint normal wholistic continuity-care, and massivelt INCREASE total workload, but without any guarantee that it will significantly reduce GP practice workload.
It will cost more. More money better spent invested in current Practices to provide same care more efficiently. Oh, and more safely and cheaply too, in the long run.
Every patient a GP sees in a long-term relationship should be enabled in better self-care from each contact. Hubs will not do this, especially if Noctor-led.

John Graham Munro 18 February, 2024 8:31 am

Why do bureaucrats never go on strike?———just a thought

Keith M Laycock 19 February, 2024 3:58 am

“in line with national direction of travel around at scale working” – Pardon?

It is madness, it is insanity, it is doomed – or it is for the patients and the Docs in GP practice as the system moves further an further into dystopia.

Centreground Centreground 19 February, 2024 8:31 am

‘At Scale Working’ like PCNs is an abysmally failed project but as expected, those who have led the past decades of failure within CCGs, , NHSE ,Royal Colleges at the behest of HMG appear oblivious to the past destruction of NHS healthcare and have hopped onto to the latest pseudo quango boards including the ICBS challenged by a wholly ineffective and detached RCGP and hence this cataclysmic decline in NHS standards will continue.

Centreground Centreground 19 February, 2024 1:01 pm

At Scale working failing as the current solution for all the current debacle was meant although as with ARRs ,selective well managed use by appropriate capable individuals /groups will be effective .

Guy Wilkinson 21 February, 2024 1:19 pm

I bet they haven’t modelled the cost to practices of losing opportunistic QOF work, immunisation and smear reminders, flu jabs.