Case study summary
Following an extensive one-year trial programme, Sheffield GPs have increased access to general practice by developing four new primary care hubs, enhanced their offering by providing additional appointments outside of usual working hours (including evening and weekends) and improved the overall outcomes through integration of key clinical systems, such as appointment bookings. Through the GP-led organisation, Primary Care Sheffield, which covers all 81 surgeries, they have helped to improve access to general practice and increase patient satisfaction.
What was the challenge?
The Sheffield PMCF was as an ambitious 16 project programme, designed to improve access to general practice and to work with partners to test a range of integrated services to support primary care service development. The primary care hubs had several key challenges prior to and during establishment. These included ensuring appropriate governance was in place and integrating different clinical IT systems, such as NHS 111 and EMIS, establishing a workforce that met population needs, whilst ensuring services were not interrupted for the 580,000 patients of Sheffield.
What were the opportunities?
By creating additional capacity through four primary care hubs offering GP, advanced nurse practitioner, healthcare assistant and physiotherapist appointments, providers would be able to relieve pressure in general practice (as well as offering better patient choice) and for other areas of the system including A&E. By integrating IT systems, services such as NHS 111 would be able to utilise these additional appointments and encourage uptake of the new services.
What did they do?
- Created four new hubs. Spread across the city, the hubs initially offered evening and weekend access to GP appointments and advanced nurse practitioner appointments. The original one-year trial was evaluated on three criteria: patient experience, GP workload impact and the effect on the broader system. The evaluation concluded that the hubs helped to relieve pressure from secondary care, particularly A&E, equivalent to 15% for primary care presentations. Services now include evening and weekend appointments, 52 weeks of the year, with GPs, practice nurses, physiotherapist and phlebotomists at the four sites around the city. A central component to this success has been the drive to complete episodes within the hubs, with 90% of cases being closed at the end of the consultation. Following the success of the trial and the positive patient feedback received, the hubs are continuing to expand and offer additional appointments with other medical practitioners. Primary Care Sheffield is in the process of opening two additional hubs on the north side of the city to increase accessibility.
- Integrated GP clinical systems. To encourage confidence in the new hubs and to improve the experience for patients using healthcare services, Primary Care Sheffield GPs resolved to integrate the practice and service clinical systems, including patient records (read and write) and appointment booking facilities. Practices can now book into the healthcare hubs and, when the hubs are closed, the NHS 111 telephone service allows patients to be clinically triaged in. It took three months to configure and enter the hubs onto the directory of services. The listing algorithm now directs suitable patients into the hubs outside of practice opening hours, further helping to increase uptake of the new services.
- Employed a clinical team from the local area. When setting up the hubs and approving the governance procedures, it was agreed that local knowledge would be extremely beneficial to the service as staff who currently live/work in Sheffield have a better understanding of the area’s local needs. As such, 95% of the clinical capacity is from GPs, nurses and physiotherapists who work in Sheffield.
What outcomes were achieved?
The extended access service has seen increasing utilisation particularly since the introduction of 111 direct booking at weekends. Utilisation for in week appointments ranges between 95-100%. Weekends are slightly lower, mostly because Sunday afternoon utilisation is around 43%. As a result of this some of the weekend capacity is now being transferred to weekday evenings.
The hubs have been highly successful with excellent patient approval ratings of circa 90% and very positive GP feedback. The extra capacity and improved access opportunities was found to relieve pressure on other areas of the system, with a baseline of an annual 15% demand reduction for Type 2 presentations in A&E. By working together, the practices have also been able to integrate with the wider system, such as secondary care services. They now develop their own winter pressures escalation plan, which enables the creation of additional capacity to offload demand from other areas. Their Easter capacity has now been tripled, thanks to the additional appointments created with the hub model.
“By providing a well-integrated and improved access scheme to general practice, we have been able to relieve pressure on A&E and provide additional capacity during key pressure points for the health service. We knew how to use our local knowledge of the city to deliver a service that works for patients and the NHS and continues to be a success today.” Steven Haigh, Director – Primary Care Sheffield.
What are the key messages to take away?
For those looking to implement similar initiatives, there are two key learnings:
- Integrating services can take time to get right. Connecting the NHS 111 service to the appointment booking system took three months, but patients are now able to securely book appointments, even when their practice is closed.
- Working with the wider system can improve outcomes for all. By offering additional capacity, Sheffield GPs have been able to develop their own pressure plans, helping to relieve pressures on other areas of the system, particularly A&E services.