Case study: GP extended access

6 May 2015
The seven-day GP extended access programme in Herefordshire, enabled through the Prime Minister’s Challenge Fund (PMCF), was established with two clear objectives – to improve access to primary care in the evenings and at weekends and to support the urgent care agenda.
 
Established in July 2014, the service has three hubs in Hereford, Leominster (in the north of the county) and Ross-on-Wye (in the south), offering a 6pm-8pm weekday and 8am-8pm weekend service. Hub teams include GPs, nurses, nurse practitioners, healthcare assistants and receptionists. Patients can access the service by phoning their GP practice or 111.
 
The 111 service and the local ambulance trust can refer to the extended access service based on their call handling/triage processes.
 
Dr Richard Dales, finance director of Taurus Healthcare and a partner GP in Mortimer, Herefordshire, said: “Before we embarked on the programme there were two risks which I had concerns about. One was whether the technology would work and secondly whether we would be able to fill the shifts. We have succeeded on both matters and that is a credit to everyone involved.
 
“During the appointments there are very robust data-sharing arrangements. When patients give their explicit consent, GPs are able to pull up the patients’ medical records and see all their hospital letters. The GP will then make a note of the consultation and the message will get back to the practice about what has happened. The practices are all on the EMIS system and this has supported seamless information sharing.
 
“The service is provided by a mixture of GP partners, salaried GPs and locums as well as nursing colleagues, healthcare assistants and receptionists. When you’re ‘out in the sticks’ and there is a shortage of available GPs, we have to find our own local market rate to ensure there is a good supply for the shifts.
 
“GPs are a disparate group, some are extremely supportive, some are wary of the changes and do not feel they have any more time for this, there’s a mixed range of emotions. What has been helpful is that all practices are members of the federation and that this is a new service, based on new funding, so we have not had to take a service away elsewhere. It takes time to get a hub up and running but a large number of GPs are involved, some regular and some like myself who do occasional shifts.”
 
Taurus Healthcare received approximately £2.7m of PMCF funding to establish a number of inter-linked projects with the extended access programme due to run for a year. It is now set to be extended to December 2015 to link in with work being completed on the local urgent care programme. Promotion of the extended access hours to patients has been via media stories, leaflet door drops, bus adverts and posters in GP practices.
 
“Levels of patient satisfaction with the service are very high. We are collecting a range of data but early feedback is showing they like the service and we are hopeful that it will show a significant impact on out-of-hours and A&E attendance. I’ve had patients see me when I’ve been working in the hub who have said it is convenient as they’ve been working away all week. Herefordshire is a large rural county but people have said that with the three hubs they have appreciated not having too far to travel to their nearest one. Some practices are a longer way away from the hub – the current model is very much a north-to-south model, ideally we would be able to make it east-to-west as well.
 
“It’s been interesting to see how the system is operating by actually working within a hub. All the directors have been keen to do some sessions. When you’re hands-on you can see the operational glitches, such as making improvements to the electronic referral form and ensuring the right information goes back to the practices.
 
“In setting up our extended access programme we’ve been fortunate to have very strong leadership from non-NHS managers, from people like Graeme (Cleland). GPs are used to working in certain ways and it’s good to have people from outside the medical world who have expertise in management and leadership. It’s been important to provide a high quality service, so that patients are seen only once, rather than continuing to be seen across the system. Our IT governance is very strong and it’s been important to be prepared to go with the market rate to obtain the staff. For anyone setting up such a scheme I would encourage them to speak to people who have already taken on the challenges, rather than re-inventing the wheel. For anyone, particularly in a large rural area, they would be welcome to get in touch with us and see if they can learn from our experience.”
 
This story features in the May issue of Commissioning Excellence. Click the link below to download the newsletter.
General Practice Case Studies

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