How this PCN…set up a same-day service for respiratory conditions

South Sefton PCN set up a same-day service to ease winter pressure on GP practices from patients with acute lower respiratory tract infections. It was so successful that it expanded and evolved. Now, it runs all year round with a full-time salaried team, covers other conditions and expects to see 38,000 patients in
the year 2024/25. South Sefton PCN clinical director Dr Craig Gillespie and PCN strategic lead Rachel Stead explain more.

South Sefton has few areas of affluence and a large number of neighbourhoods with some of the highest levels of deprivation in the UK. The South Sefton PCN (SS PCN) footprint is 156,000 patients, but deprivation levels mean that our adjusted population is 165,000.

There is a well-established link between early access to assessment and treatment and maintaining the overall health of the individual. But access to same-day appointments is a national challenge. We decided to increase capacity for these appointments by creating the South Sefton Access Service (SSAS).

Initially, SAAS was established to address the increased volume of patients with acute lower respiratory tract infections during the winter period when GP practices are at their busiest. It has been so successful that it has evolved.

The service has demonstrated great benefits for both patients and practices. Patient feedback on the service has been excellent and, as a result of the approach taken to develop the initiative, practices express greater confidence and trust in the PCN.

Aims

During the winter of 2022/3, nationally funded acute respiratory infection (ARI) hubs were in operation to deal with the very high rates of seasonal acute infections. SSAS grew from that initiative.

We recognised by month two of operation that GP triage was time-consuming, and the scope of the ARI hub was too narrow. Following a review using the quality improvement methodology of ‘plan, do, study, act’, we agreed that reception signposting and a wider scope were needed. So, we immediately expanded it to include upper respiratory tract, ear and throat infections based on presentations and also increased the number of clinics and operating hours.  

As a result, this dedicated service is now proving successful in freeing up appointments outside the winter months so GPs can better manage demand all year round.

Methods

The service is GP-led supported by a team including advanced clinical practitioners (ACPs), advanced nurse practitioners (ANPs), and trainee advanced clinical practitioners (tACP). Appointments are available with all levels of clinician and signposted by reception teams across SS PCN. Eligible patients are offered the choice of an appointment with the service when they contact their practice and they are then booked in on the same day.  

Initially, patients were seen at a single site in south Sefton on the same day they contacted their own practice about their condition. However, public transport was a challenge for some of our population.

A solution was to run clinics from a further seven local practices, spread across the SS PCN geography. The SSAS team worked with individual practices to find rooms during the week so clinics could be held there. In true cooperation, patients from across the SS PCN geography can be booked in at any of our clinics

As the senior team, we provided clinical oversight and strategic direction to establish and grow SSAS. Operationally, the project clinical lead was ACP Chris Preston, alongside lead paramedic Jimmy Carter.  SSAS service managers were Leanne Long and Pauline Needham.

The team also worked closely with South Sefton GP Federation colleagues to ensure an overview of patient safety and governance – Dr Massimo Gozzelino, Karen McKracken and Dr Ade Taiwo.

Outcomes

In the first year, we saw just over 15,000 patients – significantly more than we expected given the scale of our small start-up plan. Since launching SSAS in mid-February 2023, we have seen over 20,000 patients, and now that the service has expanded and become a full-time salaried team, we expect to see 38,000 patients in the year 2024/25. 

We see patient feedback as an opportunity to continue improving the service, so we send out an Accurx text with a link at the end of every consultation.   

To date, we have received 1,455 responses, with 95.88% of patients saying they were extremely likely (83.44%) or likely (12.44%) to recommend SSAS to friends or family. Healthwatch Sefton reports high levels of patient satisfaction with the service, and many patients now ask for appointments directly with the service rather than their own practice, which further eases pressure on general practice.

In March 2023 when the national funding ended, member practices agreed to continue the service because it had been so successful in helping them manage demand for on-the-day appointments.

The majority of the cost is for ACP, ANP, tACP and care coordinator roles and this comes from the Additional Roles Reimbursement Scheme (ARRS). There are also costs for education training grants along with monies for GP roles from the capacity and access support fund.

Hub and spoke

Establishing the service as a GP-led hub and spoke model – working closely with and on behalf of all member practices to provide clinics across the area – has been an important aspect of its success. This ‘one team’ approach enabled the service to be seen as an extension of general practice in South Sefton.

In addition, we have been able to bring healthcare students into clinics to gain experience in primary care. As the service expands, we intend to provide opportunities for GP trainees to work alongside our team.

As SSAS is embedded and integrated into the local primary care system, it has helped encourage closer working with health and care partners.  Some examples of this include helping the success of Pharmacy First by training community pharmacists in the assessment and treatment of acute ear infections and upskilling paramedics in community management of patients with acute illnesses. SSAS has also provided clinical supervision to the social prescribing team.

Future

Due to its success, the service will shortly be increasing its operating hours further from 9am-5pm Monday to Friday to 8am-8pm to boost appointments further.

In the future, SSAS plans to widen the scope of the service again to include urinary tract infections and hold additional clinics.

The service has the potential to support any future health surge requirements, quickly being able to establish ‘hot sites’ if needed due to its flexibility and responsiveness of being a PCN GP-led model.