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Same-day GP care at scale should be ‘mandatory’, says pioneer PCN

Same-day GP care at scale should be ‘mandatory’, says pioneer PCN

Exclusive Same-day access hubs should be rolled out across primary care ‘in a mandatory way’, according to the pioneer PCN highlighted in the seminal report laying out the NHS’s plans for general practice.

The 2022 Fuller Stocktake recommendations, accepted in full by NHS England, highlighted the Foundry PCN in East Sussex for its success in managing urgent demand by separating patients who need on-the-day care from those with ongoing conditions or complex needs. 

In North West London (NWL), 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, which has built on Fuller’s recommendations for same-day appointments to be dealt with by ‘single, urgent care teams’ across larger populations.

But Foundry PCN’s clinical director Dr Phil Wallek told Pulse that he agrees ‘with the principle of rolling out in a mandatory way’ across a whole area, and that primary care has to ‘do things in a standardised way’ otherwise the ‘system just can’t work’. 

He added that he has been contacted by other PCNs and commissioners about how they can roll this model out.

‘I agree with the principle of rolling out in a mandatory way. I do agree with that. [NWL is] saying it can be a PCN or a group of PCNs – it’s up to them to decide what that is,’ Dr Wallek told Pulse.

He said there is a balance to be met between allowing practices enough control but also recognising that A&E and urgent treatment centres operate at a wider level.

‘Therefore, we do have to do things in a standardised way, to some extent, otherwise the system just can’t work.’

The PCN clinical director also said they have encountered challenges to working at scale with their local community trust because their neighbouring PCNs have not adopted the model.

He said: ‘The only way that could change is by mandating a model of care for general practice, across the whole area, which means then that the community trust also has to fall in line with that.

‘That is, I think, maybe what’s happening in London. So I think that’s more sustainable as a way to approach it.’

However, Dr Wallek warned ICBs and PCNs in other areas to keep their urgent care teams ‘at a smaller scale’ in terms of the number of patients they are covering. This will ensure that colleagues maintain ‘that cultural aspect’ and their informal relationships.

‘My concerns are when you’re at that 50,000 to 100,000 population level – it’s too big for you to do it in that way,’ Dr Wallek said. 

The Foundry PCN brings together three GP practices who now operate as ‘three separate hubs for continuity’, while their on-the-day patients, labelled as ‘green’, are currently seen by GP teams at the local urgent treatment centre.

Dr Wallek said: ‘Because our GPs rotate through that, it creates a unified, joined-up, shared responsibility, teams-based approach to it, as opposed to it being a separate thing somewhere else – that’s not part of what we do.’

Since being highlighted as a blueprint for single urgent care teams in the Fuller stocktake, the PCN has had other GPs and PCN clinical directors, as well as commissioners, visit to learn from the model. 

‘Lots of people have gone away, taking some of the ideas, and then people take their own thoughts about it, and maybe make their own adjustments to it, which may or may not hold on to some of the things that make it work for us,’ Dr Wallek told Pulse. 

Last year, an evaluation of the Foundry PCN estimated that by adopting the model there could be a reduction of 12,480 non-elective bed days, 751 fewer A&E visits and 720 fewer locum GP sessions over a three-year period.

In Buckinghamshire, Oxfordshire and Berkshire West (BOB), the ICB seems to be planning a very similar model to NWL where same-day access hubs treat ‘non-complex’ patients outside GP practices. 

And in Cornwall, new ‘primary care hubs’ are being set up across Cornwall in a bid to ease same-day demand on local GP practices

But it comes as last week a new study concluded that continuity of care increases productivity in general practice by reducing the demand for GP consultations.

One of the authors told Pulse that while he was a ‘big believer’ in primary care at scale, it would be a ‘mistake’ to separate urgent care from longer-term care at an organisational level.



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

David Church 26 February, 2024 12:55 pm

Oh yes? just because they like it, why should everyone else have to do the same even in different circumstances and without the Government bribes?
What scale should be used then? – 4mm to the foot (1:76) or 3.5 mm to the foot (1:87) ?
Our patients would love to be able to get same day care at their own surgery, and cannot travel to a ‘Hub’ 90 minutes away by car, buses about 4 times a day with changes, but not sundays, and no trains.
And no access when the roads are closed by floods, which DOES happen several times a year.
Would that favoured PCN pay for the helicopter fares for our patients to use the ‘mandatory’ hub for urgent acute care??

Bonglim Bong 26 February, 2024 12:58 pm

I we now just ignoring all the articles that talked about the productivity and value of seeing the clinician?

Fay Wilson 26 February, 2024 1:06 pm

Two or three PCNs doesn’t seem like “working at scale” – noting practices will continue to do much of the work with a UTC thrown in for minor ailments. Nor does it fit the article’s headline “GP Care” since the care is mostly from PAs or prescribing HCPs. Good luck with this latest wheeze which just serves to justify further de-funding mainstream general practice. GP pracfices are the foundation on which others are building their dreams. They need to be awful not to undermine that foundation.

Fay Wilson 26 February, 2024 1:06 pm

*careful* not awful!

ANTHONY Roberts 26 February, 2024 1:19 pm

Any bets that it will not work in the real everyday world and will end up being quietly shelved and ignored in 5 years time as other wizard great ideas will have come along to replace it.
Why not properly fund the model that used to work and stop trying to reinvent the wheel?

Centreground Centreground 26 February, 2024 1:25 pm

The whole of the country complaining about Primary care and these sorts of ongoing ludicrous overgeneralised suggestions are the reasons why in my opinion.
PCNs who have wasted vast resources to the detriment of the wider patient patient cohort in my view and huge inequity across the country in how they are being managed as is widely discussed in manager forums but yet not currently reaching the attention of the public needs to be highlighted.
Again, these types of blanket suggestions we have had to endure over decades are in my personal view are the cause of the ongoing decline in Primary Care and not the solution although in restricted fortunate areas who don’t have the patient demographics of other practices they may have some benefits and selective use requires further evaluation for those who are so privileged. .
Our patients simply have not attended HUBs when based some distance away worsening health inequality and to suggest otherwise as HMG and NHSE indirectly imply is simply misleading.
However, if you are in a opportune PCN which is working why should you care about surgeries with populations who can’t access or don’t understand despite explanation how to access such centres?

Richard James 26 February, 2024 2:25 pm

Because suddenly one size fits all solutions are good?! Best of luck rolling this model out in a rural PCN.

One of the major benefits of PCNs is it puts practices/GPs in charge of how to run services/manage patients in their own area. With the loss of CCGs and consequent far less flexible commissioning, this aspect of PCNs is more valuable than ever.

So the bird flew away 26 February, 2024 2:47 pm

“at scale” – doublespeak for cheaper, lower quality, mass production of “care”. Any “Dr” who uses such phrases should hang their head in shame.
When is the House of Conmen going to legislate itself to work “at scale”?

Peter Jones 26 February, 2024 4:37 pm

The latest groan! Continuity of care through smaller practices might be old-fashioned but is the most efficient and most patient-friendly way of providing General Practice. Look at the results of patient surveys – it’s always the smaller practices which come out on top. We just need more GPs, not cheaper non-doctors (which often produces inefficiencies and duplications of effort), and hence smaller list-sizes.

Simon Gilbert 26 February, 2024 5:05 pm


“I can’t persuade GPs my plan is good so can someone force them to do what I want!”

Also, there is too much talk about Urgent and Non-urgent care.

Much of GP practice is EmUrgent Care – something that won’t kill you that day but that may or may not reveal itself over a number of appointments in a shortish (ie a few weeks rather than 6 monthly secondary care) time frame.

Rob M 26 February, 2024 7:13 pm

Seems to me that moving to separating On the Day/Urgent Care and doing so at scale is inevitable. What I don’t understand is the BMA/GPC head in the sand approach and refusal to accept that no govt is going to be able to afford what we used to consider as good quality General Practice for much longer – cheapest option per appointment at the point of use will be what’s coming regardless of the longer term costs/consequences. Why BMA not exploring how those GPs who do want to provide high quality personalised continuity of care (and in areas where such non NHS care would be feasible) can do so outside of the NHS – it’s what dentists chose to do? Appreciate its tough but do feel BMA just increasingly out of touch with the harsh economic realities of where politicians find themselves in today’s modern day near-bankrupt Britain

Wendy Kitching 27 February, 2024 8:17 am

What is the difference between what these hubs will offer and walk- in centres which used to be funded and provided by the CCGs the majority of which seem to have disappeared? reopen them and hard pushed short staffed GP practices won’t have to spread their staff even more thinly providing a service the patients will have difficulty accessing because it’s too far away – yes there are families out there who really can’t afford a bus fare let alone a taxi