Plans for same-day access ‘at scale’ will go ahead in one area after the ICB rubber-stamped a new strategy which includes ‘hub working’.
The Buckinghamshire, Oxfordshire and Berkshire West (BOB) ICB this week approved plans at their board meeting meaning ‘all neighbourhoods will be required to participate’ in the body of work that will see the introduction of same-day hubs.
It is currently unclear how practices will be compelled to take part in the scheme, but ICB leaders confirmed that ‘no specific models’ will be ‘mandated’ and development of new models of care will be ‘primary care-owned’.
Pulse reported on the BOB ICB plans in February, when patients and GPs were invited to comment on a strategy aiming to transform primary care.
The proposals are similar to the controversial same-day hub model being developed in North West London, and both ICBs have drawn on work completed by the management consultancy KPMG.
Following a ‘prolonged period of engagement’, BOB’s strategy has ‘evolved significantly’ with GP leaders and the LMC having ‘extensively shaped’ it, according to the ICB chief medical officer Dr Rachel DeCaux.
The board has now officially approved the updated strategy meaning implementation will begin.
The first priority in the strategy is to ‘expand at-scale triage and navigation to appropriately direct same-day non-complex need’, which will ‘release capacity’ for GPs to focus on patients with more complex needs.
Same-day access hubs are put forward as one way of better triaging patients, and the ICB suggested they are resourced by ‘multi-skilled staff from practices’ and housed within the existing NHS estate.
The board’s partner member for primary care Dr George Gavriel, who is also a GP, differentiated these same-day access plans from those in North West London, where it was initially mandated and funded via PCNs.
He said he challenged the ICB early in the process on their lack of engagement with primary care, but that there has since been a ‘significant change in that approach’.
Dr Gavriel welcomed a statement from Dr DeCaux during the board meeting in which she confirmed that hubs or other models will not be imposed on GPs.
‘Really importantly, no specific models are mandated. This is primary care-owned, and will reflect the needs and those of their patients. The ICB is here to support – ie, this is not a one-size-fits-all that’s being imposed,’ Dr DeCaux said.
The strategy itself stated: ‘All neighbourhoods will be required to participate in this programme of work, but it will be tailored to their circumstances.’
On same-day care specifically, the document said: ‘This way of working is emerging in parts of BOB and is in-line with the national direction of travel around at-scale working.
‘Working at-scale (eg, 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 eg, a hub could have pharmacists, physician associates, dentists and specialist nurses. This can help manage demand more effectively in a local area.’
The timelines for implementation of any hub model are not explicit, but the ICB said it will take a ‘phased approach’, working first with ‘interested’ practices.
According to the strategy, it will take ‘several years’ to embed all the changes, and the first step is to establish ‘Place Delivery Teams’ who will lead implementation from summer this year.
During the consultation period, patients and GPs raised concerns about how continuity of care will be maintained.
Similar concerns were raised by GPs in North West London, who worried that same-day hubs would lead to a fragmentation of primary care and a loss of continuity for patients.
However, BOB ICB has claimed that operating same-day access at scale will help maintain continuity of care.
In their response to feedback, ICB leaders said: ‘We understand the importance of access and continuity of care, that is why our first priority is to expand at-scale triage and navigation to appropriately direct same-day non-complex need.’
The strategy also argued that this way of working will lead to ‘enhanced staff satisfaction’ due to ‘at-scale supervision models’ for ARRS staff who can ‘rotate in and out of hub roles’.
Other elements of the primary care strategy include forming ‘integrated neighbourhood teams’ and boosting system-wide efforts to prevent cardiovascular disease.
Some patients have criticised the ICB’s plans, with the campaign group Keep Our NHS Public Oxfordshire holding a protest last month.
At the time, the group said: ‘A new model for GP practice (primary care) is in train for Oxfordshire. In our view it is a misleading label for what is essentially a series of yet more cuts. And one that would sweep away the family doctor who is at the heart of our NHS.’
Following approval of the same-day access plans earlier this week, BOB ICB reiterated that ‘no specific models are mandated’ and that it will be ‘closely working’ with local providers to ‘co-produce and implement any changes’.
A spokesperson said: ‘The final strategy was developed over the past nine months and involved extensive engagement with patients, local people, primary care colleagues, our NHS trusts, and partners whose views helped shape the final document.’
This is a flawed model arising out of unproven/unevidenced models developed entirely from an administrative/management perspective (thanks KPMG). Its drowns in administrative jargon and quasi political justifications for doing stuff which to a clinician sounds otherwise intuitively pretty stupid. Quote “During the consultation period, patients and GPs raised concerns about how continuity of care will be maintained.
Similar concerns were raised by GPs in North West London….However, BOB ICB has claimed that operating same-day access at scale will help maintain continuity of care.” Ok we can relax BOB ICB says is going to be ok. Its like something George Orwell might have written sharpening up his theories on newspeak. “ The strategy also argued that this way of working will lead to ‘enhanced staff satisfaction’ due to ‘at-scale supervision models’ for ARRS staff who can ‘rotate in and out of hub roles’.” Yeah Arse/ARRS you couldn’t/wouldn’t have done better making this all up could you
GPs ‘will not be required to engage’? I expect they will however be fined if they fail to offer their staff to work in these these initiatives.
Keeps the agenda on ARRS funding and ‘easing burden on GP’ rather than look at the real funding black hole for GP practices
Yes, KPMG are experts in General Practice and understand fully the complexities of primary care patient need. Inexperienced and minimally trained staff managing all undifferentiated presentations at huge scale. That’s obviously going to save lots of money by stopping referral onwards and upwards into a GP surgery and/or presentation into secondary care. Obviously far fewer mistakes will lead to savings in negligence claims as well. It’s a win-win for KPMG and the ICB managers.
If I remember correctly, around one third of presentations into the local walk-in centres was referred on to GP or secondary care. The walk-in centre still got paid, around 50% of GP yearly payment per patient. Obviously that saved, well, nothing actually. It created more work, and money that could have been invested in practices went into the pockets of private investors.
I’m sure KPMG understand all this of course and have a plan which will stop this. Perhaps every referral into practices carrying a fee, much as it does into secondary care? Instead of Primary Care we could call ourselves Intermediate Care?
Meanwhile in the real world, the dumb ignorance of their strategy, as MM posted above, is summed up in the statement “The strategy also argued that this way of working will lead to ‘enhanced staff satisfaction’ due to ‘at-scale supervision models’ for ARRS staff who can ‘rotate in and out of hub roles’.” Well who’d have thunk it??
So much for continuity of care?
Bucks, Berks and Oxfordshire – BuBO would have been the correct acronym for this excrescence on primary care…
a sad day for patients, doctors, and the English language
Worse day for anyone called Bob living there when locals start saying “BOB’s bloody crap”… 😉
My recent article in the BMJ discusses some of these issues.
The future of NHS primary care should focus on integration not fragmentation
https://www.bmj.com/content/385/bmj.q1087
So much for continuity of care, thats obviously out this month