CPD: How to implement enhanced access across your PCN

Dr Saul Kaufman and Yasmin Bouzelmate advise on what practices and PCNs need to do to provide routine Saturday access 

This module will help you gain an understanding of:

• The enhanced access scheme merges the existing funding for the current PCN Extended Hours DES (£1.44 per patient) and CCG Extended Access service (£6 per patient) 
• The DES requires PCNs to offer a minimum service of 60 minutes per 1,000 PCN-adjusted patients per week
• The service must cover all 15.5 hours of the extended hours period – 6.30pm to 8pm Mondays to Fridays, and 9am to 5pm on Saturdays 
• The service can be provided at a single location or across several premises in your PCN 
• Appointments must be mixture of in-person face-to-face and remote (telephone, video, online); 25% of appointments should be online
• The Network DES specifies that IT interoperability should in effect be seamless, but it is clear this is not yet achievable and the PCN may need to explore workarounds in the meantime
• PCNs should review how their service fits in with wider local urgent care services

Dr Saul Kaufman is a PCN clinical director and a GP in Westminster. Yasmin Bouzelmate is operations manager for Central London Healthcare CIC federation

The latest Primary Care Network (PCN) DES stipulates that from next month, networks must start offering routine access on Saturdays – or, as NHS England calls it, ‘enhanced access’. This is in addition to the currently required extended evening services. 

The announcement about enhanced access prompted an outcry, and subsequent announcements from NHS England gave mixed messages on what kind of service would be required, and whether a GP would have to be available either in person or on call. 

In reality, the new DES consolidates the national Extended Access scheme and those run locally. For some PCNs, there will be little difference in their provision. Others, though, might find it more difficult, especially those whose member practices had not been part of the previous schemes, as these new requirements are compulsory for all PCNs. 

However, this could be a great opportunity for PCNs and practices alike to review their current non-core hours service to decide which aspects would best be delivered at scale. This could extend the breadth of services available to patients through work with other PCNs and existing providers.

PCNs have already submitted their plans, but there will be refinements. Here, we will examine how to best deliver the service and which points should be considered at this stage. 

Organise the workforce and offering
The enhanced access service will need a balance of urgent and same-day care, and PCNs should ensure a range of services is provided to the population and overseen by a wider multidisciplinary team.   

The key requirements of the DES include:

• Same-day online booking must be made available for appointments where no triage is required, as close to the appointment timeslot as possible. This will vary and your clinical lead may decide which clinics do not require triage – for instance, routine childhood immunisations or cervical smears. 
• A mixture of face-to-face and remote (telephone, video, online) appointments must be offered.
• A variety of clinical services should be offered, including, but not limited to: childhood immunisations; cervical smears; wound care; flu vaccinations; contraception services; ear syringing; phlebotomy. These should use the wider primary care workforce.

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