About wave two pilots
- Access MK – Improving access to General Practice in Milton Keynes
- Achieving Excellence in General Practice – The West Cheshire Way
- An Enhanced Integrated Primary Care Model for Sheffield
- Best Care, Anywhere: Integrating primary care in Coventry
- Cannock Practices Network – Improving Patient Access Project
- Collaborative Pilot: GP Health partners Ltd: Step Change towards Multispecialty Community Providers – Epsom
- Community Primary Care HUB clinics in Basildon and Brentwood
- EASTIR: Extended Access and System Transformation in Richmond
- Further Improving Access to GP Services Over 7 Days in Wigan
- GATESHEAD EXTRA Care
- I HEART Barnsley
- Implementation and establishment of the Neighbourhub model – Knowsley
- Improving access in Lambeth
- Improving Access to Health Care across Fleetwood
- Improving Access to Primary Care in Blackburn and Darwen
- Improving and integrating access in primary care in Leicester delivered through locality hubs
- Islington i-Hub
- Joining up your Primary Care in Gloucestershire
- Manchester Access
- My Healthcare – South and Central Birmingham
- Primary Care Access Centre: Improving access and choice for local people in New Forest
- One Care Consortium – Bristol, North Somerset and South Gloucestershire
- Our Time for Change – Windsor, Ascot and Maidenhead’s Shared Ambition for Primary Care
- Primary Care 2.0 – West Leeds
- Primary Care Transformation Programme Peterborough
- Pro-active, Accessible and Coordinated: Transforming General Practice in Tower Hamlets
- Right Time, Right Place, Right Care – Oxfordshire
- South Tees Access and Response (STAR) Scheme
- Southampton City Primary Care Hub
- “SUCCESS” – Swindon Urgent Care Centre & Expedited Surgery Scheme – Improving access to general practice
- Staying Well in South Worcestershire
- West Essex 7 Day Primary Care Innovation and Integration Project
- West Midlands Primary Care Workforce and Improved Patient Access Plan
- Working Together to Transform Primary Care in Ipswich
- Multispecialty Community Provider Pilot in Worthing and Adur
- Together for the health of Haltom
- Transforming Primary Care in South Cheshire and Vale Royal
1. Access MK – Improving access to General Practice in Milton Keynes
This scheme brings together 22 GP practices to offer 229,559 patients increased access to bookable GP appointments. This include appointments in the evenings and weekends with 8am-8pm access Monday to Friday and 8am-2pm at weekends, which will provided through five hubs within the locality which went live in September. Once fully up and running the scheme will provide an additional 500 appointments per week across five primary care locations. As all practices within Milton Keynes are on the same system, these appointments will be booked through the patients’ own practice and can either be face to face, email or telephone consultations. Phase one of the scheme commenced in September with full roll-out planned from November.
The scheme will also offer improved direct access to extended specialist services for children and young people and older vulnerable and complex patients. Direct referral systems will be developed for access to the specialist teams and expand the development of an adult ‘virtual ward’ as an alternative to hospital based care. Extended funding for the specialist services for children has already been agreed by the CCG allowing nursing appointments to be made on a longer term basis.
2. Achieving Excellence in General Practice – The West Cheshire Way
This scheme will allow the 37 practices in West Cheshire to transform the way their 257,000 patients access GP services and the care that they receive. It will also increase options for patients who need support from other parts of the sector.
The scheme focuses on four key projects which went live in July: in hours access; extended access; care for vulnerable older people; and care for people with long term conditions. It will take a holistic approach to treating patients, providing support to access alternative services where appropriate. This will include introducing wellbeing coordinators to navigate the voluntary sector on behalf of patients, and providing direct access physiotherapy services when appropriate.
Patients will have access to primary care services until 9:30pm through the week; from 9:00am-2:00pm on Saturdays, and 10:00am-3:00pm on Sundays, providing an additional 328 appointments per week. The aim is for those patients with urgent needs to be seen by the right health professional, in the right place, at the right time. Delivery will be underpinned by greater use of technology through video consultations and by using mobile apps to help patients understand and improve their own care. It will also allow mobile working which will enable health professionals to provide enhanced care to patients in the community.
3. An Enhanced Integrated Primary Care Model for Sheffield
Working together through the access fund, general practice in Sheffield will improve access to urgent primary care appointments for 580,000 patients, reducing avoidable emergency admissions and unnecessary attendance at A&E.
The 16 scheme project is split into two tiers, with practices able to choose their level of engagement. Level one includes an acute same day service, additional pharmacy support, and secure data sharing across primary care, secondary care, mental health and social care. The second level includes all of these, with the addition of a rapid access GP team, out of hours urgent care provision through four satellite units, wrapped around services which will provide GPs with additional out of hours support from social care and mental health services, Roma advocacy and health support for practices with a high Slovak Roma population, and access to self-management tools and signposting for patients through Web GP. The majority of practices have committed to the second level (77) with six committing to level one. All 16 projects will become fully operational and accessible by the end of October 2015. Nine practices have already signed up to pilot Web GP, of which four have now gone live.
From October 2015, the scheme will be providing increased access to primary care services seven days a week, offering patients appointments 6pm–10pm weekdays, and 10am-6pm at weekends from four satellite units, three of which are being set up specifically through this initiative and one as an extension to an existing out of hours service.
4. BBest Care, Anywhere: Integrating primary care in Coventry
Coventry’s ‘Best Care, Anywhere’ programme is providing a cohesive solution to improve primary care access and ensure continuity of care through integrated pathways.
Two of its three programmes are already well established, with a GP based in the Emergency Department (ED) and a practice nurse based in A&E at peak times to treat primary care cases presenting to ED.
A Primary Care Frailty Team based at Coventry’s main hospital has been created to increase the capability of primary care to offer comprehensive management of frail, elderly patients and to do so from both an acute and community setting. Supporting frail elderly patients to exit hospital with a comprehensive care plan is the team’s main focus and they have established a pathway for holistic planning and discharge for complex, frail patients with community follow-up care.
The third aspect of this scheme is a GP extended hours hub, which is a single hub offering weekday (4–8pm) urgent appointments and weekend routine appointments (8am–2pm). This service has been live since September.
Overall, this scheme covers 64 GP practices with a patient population of 374,335.
5. Cannock Practices Network – Improving Patient Access Project
The focus of the scheme in Cannock is to achieve a collaborative approach in providing late afternoon, evening and weekend surgeries, giving patients access to additional GP and Nurse Practitioner appointments. This primary care service has been available to patients since September, offering increased access from 8:00am-8:00pm on weekdays, and from 9:00am- 1:00pm on Saturdays and Sundays.
Nurse Practitioners in the surgery will see and treat minor illness cases and provide health promotion advice, including smoking cessation and dietary advice, in order to empower patients to assist in managing their own care.
It is anticipated that the time freed up in individual practices as a result of this new service will allow a greater focus for them to develop improved support for patients with long term care conditions, such as the frail elderly, through the provision of dedicated surgeries.
6. Collaborative Pilot: GP Health partners Ltd: Step Change towards Multispecialty Community Providers – Epsom
Primary care services will go live in October for this scheme, providing increased access from 8:00am-8:00pm Monday to Friday, 8:00am-1:00pm on Saturdays, and 8:00am-12:00pm on Sundays. These weekend services will be available via three local hubs.
Patients will benefit from a greater diversity of consultation types and lengths, including greater use of telephone, online and video consultations.
The development of Community Medical Teams in collaboration between acute care, primary care, social care, ambulance services, third sector, NHS 111 and out-of-hours will support more vulnerable and frail patients. Further work will develop a community based clinical triage system with home visiting services, including nursing homes and patients that have recently been discharged form hospital. In order to help empower patients to take an active role in their health care plan, a voluntary personal care record will be available.
7. Community Primary Care HUB clinics in Basildon and Brentwood
The approach of this scheme is to deliver improved access seven days a week, from 8:00am-8:00pm, through multiple community-based primary care HUB clinics. These clinics will provide patients with extended access to the full range of integrated primary and urgent care services which can be delivered safely and effectively in the community, and will also feature a HUB clinic based in the fracture clinic on weekends and public holidays.
The aim of these HUB clinics is not only to increase capacity in primary care but also to encourage effective collaborative working between GPs and other providers in the community. This will reduce reliance on secondary care services, whilst promoting patient education and awareness of alternative health care services, including community pharmacy, community dentists, community optometrists, patient self-help, online and digital healthcare resources which will be available to patients October/November.
8. EASTIR: Extended Access and System Transformation in Richmond
This scheme has four key components: primary care hubs; innovative use of IT; managing demand, creating resilience in the system and extending access; and integrating care in community.
All four hubs sites went live in October 2015 and provide GP appointments, both face to face and telephone, as well as nurse bookable appointments. The hubs run seven days a week and support the delivery of interoperability between hubs and all practices in Richmond. This means that clinicians in the hubs can read and write directly into the patients records.
The Richmond Health Care Navigators due to go live at the end of October. This app with an associated website will direct patients to appropriate services.
The scheme has worked with its partners in health and social care to integrate services and will be offering additional access to primary care appointments for children under five years of age, as they are high users of urgent care services. They are also enhancing a community rapid response service with a GP, which would mean that emergency home care packages could be put in place much earlier and much later in the day, managing patients at home whenever possible to avoid unnecessary admission to acute care.
The installation of video conferencing will enable patients and clinicians working in the community to test the use of this technology in consultations and advice. It is anticipated that this will be available from November 2015.
9. Further Improving Access to GP Services Over 7 Days in Wigan
Local analysis and engagement with residents in Wigan showed the current model for accessing primary care was neither consistent nor optimal, particularly outside working hours. The scheme aims to improve these services by the following mode:
- Creating an access point in nine locations across Wigan, 6:30pm-8pm, five days a week, and 10am-4pm over weekends and bank holidays. This will be accessible via booked appointments in primary care (local general practice and GP OOH) and referral from A&E or other agreed urgent care access points.
- Access to patient primary care record via integrated systems and referral using choose and book.
- Rapid telephone management by senior clinician to support robust demand management and balance the needs for same day demands with the needs of patients who require continuity of care for planned care needs.
- Alignment and consistent application of access policies across general practice
There are three sites operating a full service accessed by the 63 practices across the Wigan conurbation with another site going live shortly. Early feedback has shown that demand is higher than capacity and the scheme have now committed to having the other six sites operational by mid-November.
Patient feedback to date is extremely positive.
This scheme aims to provide a seamless service which will increase access and capacity to routine primary care services. The consultations will take a range of forms including telephone, face-to-face, or a home visit where appropriate. GP services will be delivered from three centres in Gateshead providing improved access hours 8am-8pm Monday to Friday and 9am-2pm at weekends. This service, which went live in September, will be accessible to all 206,404 patients of the 31 GP practices which have agreed to form part of the scheme.
Remote consulting and virtual ward rounds will be piloted as part of the weekend home visiting service. Care navigator posts and dedicated frailty nurses are now being trialled in West/Inner Gateshead and South/Central Gateshead localities, with a primary care transformation team appointed to the CCG to support and sustain new models of working.
Creating physical and virtual primary care improved access hubs that provide fully integrated improved out of hours care is the aim of the ‘I Heart Barnsley’ scheme.
Primary care services will be provided from 8:00am-10:00pm Monday to Friday, with an offer of over six hours across the weekend (10:00am-1:00pm Saturday and Sunday). This will result in the scheme creating an additional 65,000 GP and nurse appointments each year for the 248,747 residents of Barnsley. An official launch event was held on 26 October 2015 with a full service go-live date of the 2 November 2015.
For patients who may have many complex health and social care needs, there will be a wrap-around service that brings together the various people who can support them, in order that the patient will not have to find their own way through what is considered the current complex system. This will mean more personalised, joined up care – and fewer trips to hospital.
To increase capacity and service access, the Primary Care Improved Access Hub will give patients access to varying appointment formats including face to face, virtual video visits, email consultations and telephone appointments.
12. Implementation and establishment of the Neighbourhub model – Knowsley
This scheme will benefit almost 162,000 patients across 32 practices. Extended hours provision has been live within the locality since May, and the funding will accelerate the implementation of ‘neighbourhubs’. These hubs will provide improved access to local GPs through extra appointments and home visits, giving patients a responsive, flexible service 8:00am-8:00pm, five days a week. Services at the weekend will be provided 9:00am-2:00pm on a Saturday and 10:00am-2:00pm on a Sunday.
The scheme will also improve access through the development and innovative use of technology.
Implementing the neighbourhub model will create primary health and social care teams that deliver locality based physical health, mental health and social care for the population. This includes prevention and lifestyle advice, and the development of enhanced quality standards for nursing and care homes through integration with community, voluntary and other services that support patients, their families and carers.
13. Improving access in Lambeth
‘Improving Access’ aims to transform primary care in Lambeth. In addition to creating extra capacity for appointments it will enable proactive care for their frail adult population and reduce avoidable admissions to hospital.
This scheme has established four neighbourhood access centres across Lambeth, opening 8:00am-8:00pm Monday to Friday, and 10:00am-6:00pm on weekends. All four hubs went live in September.
Around 378,000 patients registered with 47 practices in Lambeth will benefit from these improvements, which will create 500 additional hours of service per week. This equates to 2,600 of additional face to face GP and nurse consultations per week.
Lambeth are also introducing a system of reviews for people with long term conditions, as well as developing alternative ways of accessing primary care using new technologies.
14. Improving Access to Health Care across Fleetwood
Four GP practices in Fleetwood are working together with an aim to reshape GP services across the area and deliver a more patient-centred and integrated GP service for 30,000 patients.
Longer opening hours have been made available since July for all patients, running 6:30am-8:00pm weekdays and 9:00am-1:00pm weekends. Additionally, alternative consultation formats will be offered including telephone consultations, video calls, e-mail, Pharmacy Minor Ailments scheme, SMS service and NHS accredited smart apps. These additional services are currently being scoped for October.
There will be increased focus on joined up urgent care and out of hours care for those most in need. The scheme will work towards social inclusion using digital technology, increasing access services and online support for 30 priority households.
The scheme will also be targeting increased dementia screening and on-going support post-diagnosis.
15. Improving Access to Primary Care in Blackburn and Darwen
The key work stream for this scheme is extended access which began providing pre-booked GP appointments at weekends in April this year. These appointments have proved popular and GP uptake at weekends has been encouraging. Extended access will take two forms, locality spokes launched in September offer additional capacity 8am-8pm weekdays and 8am-1pm at weekends. The Primary Care Access Centre (Hub) will offer further capacity 8am-8pm weekdays and 8am-8pm weekends.
The scheme is also providing nurse clinics which have been designed to maximize benefits for patients. Currently the scheme is offering a number of transactional type clinics for blood collection, smears and health checks. Feedback from patients is very positive and the sessions are always fully booked. Patients attending these clinics are usually well and find it difficult attending practices during standard operating times.
The use of other forms of patient access is key to the success of the scheme. Practices are beginning to mobilize video consultations and to support this a cohort of patients have been identified to lead a trial around digital inclusion. This trial will include provision of an Ipad device to enable them to access advice on their condition and also take part in video consultations.
Encouraging patients to take greater ownership of their health is a key deliverable. The Florence telehealth system actively supports the self-care agenda and has been rolled out to patients with a variety of conditions who are now able to manage their conditions remotely. These patients have greater confidence and now attend the practice less frequently.
16. Improving and integrating access in primary care in Leicester delivered through locality hubs
The GP practices within Leicester City identified a need to build a new environment for primary care provision based around four locality hubs situated within identified Health Needs Neighbourhoods (HNNs). These went live in September 2015.
Patient will have access to the extended hours services which operates from 6.30pm-10.00pm Monday to Friday and from 9.00am-10.00 pm on Saturdays, Sundays and bank holidays. This will provide a service for 62 GP practices and cover a population of almost 376,000 patients.
Work is also underway to provide online consultations to patients by way of the Online Doctor tool, this will be tested at practices prior to a phased rollout.
This scheme will extend GP hours in Islington during weekday evenings and weekends. It will offer all registered Islington patients the same services that they would expect if they went to see their own GP or phoned during current opening times. Hubs will be configured to offer the necessary additional capacity to provide 8am–8pm, seven days per week across the borough which went live in October.
Services will be provided at three hubs located within existing GP practices across the borough. Each will be staffed by a GP, nurse, and two receptionists. The primary patient interface will be via a VOIP telephone network, staffed by two call handlers and a triage doctor. It will provide just under 400 appointments each week for both GPs and nurses, the majority at the weekend. These appointments will comprise a mix of advanced and on-the-day (ratio 2:1), bookable four weeks in advance. It will be further supported by video-based consultations alongside telephone during the period of the scheme.
The I:HUB team has created an advisory board as part of its governance structure, which includes CCG, LMC, Healthwatch and lay representatives, along with clinical representation from outside the borough and academic representation regarding the measurement and evaluation programme.
18. Joining up your Primary Care in Gloucestershire
This scheme will introduce over seven locality led care centres and GP networks across 83 practices to deliver an additional 100,000 appointments per year and an additional 310 at weekends. These additional appointments are already available in Gloucester, offering patients appointments seven days a week from 8:00am to 8:00pm. Cheltenham went live in September and other localities will follow in October/November.
The scheme began implementation of e-consultation (AskMyGP) to over 30 GP surgeries which will cover in excess of 250,000 patients. Implementation and training will lead to a model for deployment across all practices from October onwards. Patients are also currently benefiting from technology with the introduction in September of a health ‘app’ to direct all 631,000 patients to the most relevant service for their needs. In addition, plans are underway to introduce video consultations to up to 10 GP surgeries across the county.
Expansion of social prescribing services to all practices serving up to 450 patients is a key aim of the scheme. This is progressing well with additional advisors already recruited, trained and providing valuable support. An aspect of the scheme providing GP telephone advice and support to the community, led by the Rapid Response service, dealing with frail patients will be operational by October along with specialist nurses who will provide up to 240 hours of support to GP surgeries. An additional initiative starting later in the autumn will see planned GP appointments taking place over the weekend.
The Manchester Access scheme is enabling all residents in Manchester to have access to GP services from 8am-8pm, five days per week and services at the weekend will be provided on both Saturday and Sunday 10am-6pm. This is proving to be of particular benefit for people who struggle to access GP services during existing core hours or find it difficult to manage their healthcare needs around busy and hectic lifestyles, such as parents of young children, people with carers, carers themselves and the workforce.
This service will be available to almost 600,000 residents registered at 92 practices and will both complement and integrate with existing primary care. Excellent progress has been made in selecting and mobilising our hubs, with patients and ‘home’ practices already benefiting.
The scheme aims to provide an additional 131,000 GP appointments and an additional 100,000 practice nurse and health care assistant appointments per year. The service will offer innovative methods of access including telephone access, a smartphone app as well as a patient website, which will provide details of all local services, self-help information along with a portal for patients to provide feedback.
Appointments will be available at twelve primary care hubs within local communities and also at the Emergency Departments at North Manchester General Hospital, Central Manchester Foundation Trust and University Hospital South Manchester. The local acute trusts have been very open to plans and are highly engaged as service readiness approaches. Eight of twelve community hubs have successfully mobilised and are on track with the phased rollout to the final four.
20. My Healthcare – South and Central Birmingham
My Healthcare is extending GP opening hours and redesigning the interface between primary care, community based services and urgent care providers so that patients are able to access a full range of GP services via a single point of contact. These will be complemented by pharmacy, nursing, lifestyle, and health and wellbeing services to create a more seamless pathway.
This is being achieved using a hub and spoke model. The main hub at West Heath Medical Centre went live on 1 July 2015. All seven practices within three miles of the West Heath hub are now able to access the extended hours appointments between 8.00am-9.00am and 6.00pm-8.00pm weekdays, and 8.00am-3.00pm Saturdays and Sundays. The two local hubs at River Brook and Fernley Medical Centres went live during the first week of September 2015.
The three physical hubs will be supported by a virtual hub based at West Heath Medical Centre from the 1 November. The Roving Doctor Service home visiting service also went live at the start of September and has been warmly received.
The practices serve a total practice population of 45,321 patients. Patients will also benefit from self-care mobile phone apps, access to assisted living, remote care planning, supported self-management services, personalized health records and remote monitoring.
Work is also underway to deliver a virtual pharmacy service based in the virtual Hub, ECG and CRP diagnostics, community based MSK services, embedded Case Managers, Nursing Homes integration, and a befrienders-navigators service designed to support patients with non-clinical needs.
21. Primary Care Access Centre: Improving access and choice for local people in New Forest
This scheme will establish a primary care access centre delivering an integrated primary care service providing both routine and urgent care from a central location within South West New Forest.
This service, which went live in September, offers appointments 8:00am–8:00pm seven days a week via a Primary Care Access Centre for both routine and urgent cases. This scheme will offer an integrated urgent care service, co-located with a minor injury unit, receiving direct bookings from NHS 111 and emergency departments.
This is a joint venture between six practices, Southern Health NHS Foundation Trust and local partner organisations. The centre will have on-site access to diagnostics and community teams based at the hospital.
Work is also underway to test WebGP/e-Consult at all member practices of the scheme, going live from November 2015. Over 61,000 patients served by the scheme will be offered video or face to face consultations with either a GP, nurse, community pharmacist or physiotherapist, dependant on need.
22. One Care Consortium – Bristol, North Somerset and South Gloucestershire
One Care Consortium’s vision is to enable a consistent, responsive, 24/7 approach to primary care provision across all of Bristol, North Somerset and South Gloucestershire, underpinned by an integrated delivery platform.
Patients registered at any practice in this area now have access to pre-bookable GP appointments at weekends and bank holidays through the One Care Consortium weekend reviews. From September 2015, healthcare professionals working in both this and the local GP out of hours service will have access to the full GP record when consulting with patients. The next step will be for clinicians to write directly into the patient’s record and book appointments across primary care organisations, providing weekday appointments from 8:00am to 8:00pm and weekend appointments from 10:00am to 6:00pm on both Saturdays and Sundays.
The scheme is planning additional seven-day access programmes, both in and out of core hours, with a focus on utilising healthcare professionals other than GPs. The first of these is a see/hear and treat acute MSK service – patients will have same day access to telephone or face to face appointments with a physiotherapist instead of their GP. The phased rollout of this service will begin in November 2015.
A number of practices are also currently testing the web-based access tool – WebGP. This enables patients to get advice from their practice without having to ring first and will have had a phased rollout by December. Practices are also testing a single primary care intranet solution which will be implemented in all practices in the area by spring 2016.
23. Our Time for Change – Windsor, Ascot and Maidenhead’s Shared Ambition for Primary Care
17 practices covering a patient population of 155,873 form this scheme. In August it launched two community hubs at King Edward VII Hospital, Windsor and St. Mark’s Hospital, Maidenhead, offering weekday evening and weekend appointments which are monitored on a daily basis to ensure they are booked in a fair and equitable way. Patients are already providing positive feedback and DNAs are less than 2% in first three weeks of operation.
In September, the scheme launched the following additional projects:
- Care Home Plus Service: A GP care home visiting service to ensure care home residents are seen in a timely manner. The GP will proactively conduct ward rounds and staff education when not on a call. The service will be offered Monday-Friday from 8.30am-6.00pm, including one day taking primary care into sheltered accommodation and a rolling programme of healthcare.
- Capacity-Demand Project: Providing a project manager to work with four practices to understand capacity-demand challenges and develop a model of good practice.
- LTC Health Coaching: Focused at working dietetic patients who are finding it difficult to manage their condition, ANP tele-health coaching services will be available during the evenings and weekends.
- Mental health service: Hosting a CBT for carers group and a memory clinic in the hubs at weekends, as well as a clinical psychologist offering weekend sessions.
- Specialist clinics such as dressing, flu, diabetes, COPD.
The communication, marketing and PR campaign has also began aiming to educate the public on three focussed themes –
- Guess who needs a GP? – Signposting people to the most appropriate health care service.
- Call2Cancel – Putting value back onto primary health appointments by highlighting the consequences of non-attendance.
- SelfHealth – Self-management of one’s own health and the health of others
24. Primary Care 2.0 – West Leeds
37 practices in Leeds West CCG are rapidly developing the methods they will use to ensure that their 366,000 patients have a much greater choice to access their healthcare.
Currently, 15 practices are providing services seven days a week and 18 practices are delivering extended services five days per week (7.00am-7.00pm or 8.00am-8.00pm). Services at the weekend will be provided 8.00am-4.00pm on a hub basis. To complement the local progress that has already been made, the CCG is developing comprehensive online services with systematic approaches to self-care.
The extended access scheme is beginning to demonstrate that there is increased primary care availability – showing an additional 7925 appointments each week which relates to an additional 1055 clinical hours a week. It has also increased positive patient experiences with a survey undertaken by local Healthwatch showing 88% of people declared that they are satisfied with opening hours. Further statistics have also shown a positive impact on A&E and out of hours services.
This scheme launched Pharmacy First in July, and the team is currently working hard to develop and begin the proactive and targeted pharmacy interventions for patients with COPD.
As well as this, there are two e-consultation programmes which have begun and the scheme is continuing to roll-out plans for video consultations. These video consultations will offer vital and instant support to a multi-disciplinary team during case conferences as well as in nursing homes.
25. Primary Care Transformation Programme Peterborough
The 29 practices in this scheme have organised themselves into three hubs, serving populations of up to 100,000 patients, supported by the planned formation of a new “umbrella” organisation for primary care in the locality. The new system will offer extended and more innovative access to a patient population of over 252,000, using the latest technologies, including video consultations and mobile working solutions, in order to support effective collaborative working between practices, community teams and hospital services.
This scheme, which went live in August, will see 27 of the 29 practices provide increased access with appointments 8.00am-8.00pm on week days, ultimately available through direct booking of appointments via NHS 111. At weekends as well as bank holidays, 8.00am–8.00pm primary care will be offered in front of the Emergency Department at Peterborough City Hospital.
The scheme is also looking to promote 24 hour access to primary care through the online service ‘WebGP’.
26. Pro-active, Accessible and Coordinated: Transforming General Practice in Tower Hamlets
Patients in Tower Hamlets will benefit from the creation of four locality hubs and a virtual hub extending the existing success of weekday general practice care to weekends and integrating the existing GP out of hours service. The four locality hubs will provide improved access 8.00am-8.00pm across weekdays and weekends, which began with the South West hub going live in September and the remaining hubs going live by 11 November 2015.
The scheme is also working to address the cycle of demand through a DIY health project that supports patients and health professionals co-produce more resilient responses to health questions, developing health connector roles to give staff the skills and techniques to support patients in making positive health choices rather than seeking unnecessary clinical appointments, and a systematic social prescribing service for the borough so that people will be able to access support from voluntary sector partners.
In addition to this, the scheme is developing local pharmacists as independent prescribers, as well as weekend mobility clinics for children and young people to explore how local partnerships can support the delivery of seven day working.
Enhanced technology across all of the 36 practices in Tower Hamlets will support access to and the delivery of primary care, as well as supporting patients in managing their own health conditions. This will include access to web-based support for self-care and online consultations through e-consult, currently available in 23 of the 36 practices.
27. Right Time, Right Place, Right Care – Oxfordshire
The Oxfordshire GP Federation, covering 72 practices and a patient population of almost 744,321, is testing a variety of innovations across the county, aiming to improve patient and carer experience of local primary care. This includes extending appointment access outside core hours, in order to provide a further 15,600 consultations on weekdays and at weekends (7:30am to 8:00pm), strengthening the support available for those with the most complex needs and introducing new ways of accessing services.
Innovations include eight same day access neighbourhood hubs run by GP-led multi-disciplinary teams (of which four went live in September with the remaining four live at the end of October). The Federation is also offering digitally enabled remote access, including email and online video consultations, early visiting teams enabling the provision of 21,500 urgent assessments annually to help prevent avoidable hospital admissions, care navigators supporting patients with the most complex needs, 14,500 twenty minute appointments and a new interactive online health resource, providing the Oxfordshire population with the information they need to better manage their own health.
In June 2015, an early visiting service began, aiming to provide a more responsive service for patients at risk of admission, providing early support before their condition deteriorates. During the same month, an e-consultation programme was launched, providing quick response appointments during early mornings, evenings and Saturday mornings. Routine e-consultation appointments are available for patients during normal opening hours. Current feedback from both GPs and patients has been positive, and the addition of iPads to supplement the service in October should increase the patient experience further.
28. South Tees Access and Response (STAR) Scheme
The aim of the STAR scheme is to provide a high quality, integrated and innovative primary care service outside current core hours of care, led by general practices across Redcar, Eston and Middlesbrough.
This scheme will establish integrated hubs that will extend GP access for nearly 290,000 patients from 6.30pm-9.30pm on weekdays, and 8.00am-8.00pm on weekends and bank holidays. In Redcar and Eston the hubs both went live early October. The Middlebrough hub went live at the end of October.
This scheme will also integrate the current NHS 111 service, GP out-of-hours and walk-in centres, providing medical support to out-of-hours community services, ambulance services and care homes. Patients will be able to access the service via triage through NHS 111 who have capability to offer directly bookable appointments.
In November and December 2015, telephone and web-based video consultations will also be introduced as alternative ways of patients gaining access to their local clinicians.
29. Southampton City Primary Care Hub
This schemes supports 269, 875 patients from 33 GP practices, providing them with access to improved services across Southampton via six hubs. The first of these six hubs opened in June and offers GP and HCA appointments from 6:30pm-10:00pm in the evenings and 8:00am-8:00pm at the weekends. Two further hubs went live in September with the remaining three hubs to come online as part of a phased rollout throughout October.
Information technology offerings from the hubs will feature e-Consultations and e-Feedback for patients which will be phased across the hubs in early 2016. From September 2015, the scheme will also offer patients a physiotherapy service delivering primary care physio in evenings and weekends, alongside a pathway redesign to support GPs as first contact for patients with musculoskeletal problems.
This scheme has worked with Southern Health Foundation Trust to develop a new Tier 1/2 mental health service with three Band 4 Treatment, Recovery and Support workers and a Band 6 CPN. This involves a significant amount of signposting to local service providers, including voluntary and faith organisations. This went live mid-September.
In addition to these service offerings, each GP practice will be supported through IT developments in order to enable read and write back functionality across the hubs so GPs may record consultation outcomes of patients.
30. “SUCCESS” – Swindon Urgent Care Centre & Expedited Surgery Scheme – Improving access to general practice
The scheme seeks to expand access for 230,000 patients registered with 26 practices in Swindon, Highworth and Shrivenham using an innovative, locally developed model. Its focus is on delivering a range of key services including a nurse-led children and young person’s service, and GP-led urgent care clinics, plus an urgent home-visiting service which provides additional consultations for housebound patients. This combination of additional services will operate between 8.00am-8.00pm each week day. Since launching in June, the clinics are now available in two hub locations and capacity for the urgent home visiting service has increased.
The scheme will provide patients with access to a modern integrated urgent care system supported by one central point of telephone contact. This will further enable patients to obtain high quality and timely advice when they need it, 24 hours a day, 365 days a year.
The overall strategic aim of this scheme is to provide the opportunity to reinvest released resources in terms of manpower and facilities, with the intention of supporting patients with long term conditions and complex care needs such as diabetes, heart failure and end of life care.
31. Staying Well in South Worcestershire
‘Staying Well’ aims to influence how 297,251 patients in the 32 practices use the local health system, avoiding urgent care and offering different types of extended access beyond traditional core hours, as well as introducing new routes to attract people into primary care in a way that suits them best.
From September, patients will be able to get evening and weekend appointments face to face as practices will be coming together through four locality-based hubs across South Worcestershire. Open from 6:30pm-9:00pm on weekdays and during the busiest times locally at weekends, they’ll be able to get the same high quality care close to home, from clinicians who can access their records directly.
Patients will be able to get same day primary care consultations seven days a week through a multi-disciplinary virtual hub (8:00am–9:00pm on weekdays and 9:00am-9:00pm weekends) offering up to 104,000 consultations per year.
Using a range of methods including telephone and email, patients will get same day consultations with a team of highly trained and skilled health professionals who will have access to their patient record. If a face to face appointment is required during practice hours, the hub team will have the ability to book a same day appointment in community pharmacy (10,000 consultations per annum) or with a GP practice (an additional 52,000 consultations will be available per annum). Whenever possible, staff will aim to book the appointment with a patient’s own GP to ensure continuity of care.
32. West Essex 7 Day Primary Care Innovation and Integration Project
The scheme in West Essex encompasses 38 GP practices and a total patient population of 297,043, and aims to improve primary care access for the population of West Essex CCG with a special focus on those patients at risk of A&E attendances and unplanned admissions, by maximizing collaborative working across primary cares “in and out of hours” services.
Whilst the scheme has a multi-agency approach, it will be led by general practice. The aim is to achieve enhanced access to primary care services, initially 8:00am-8:00pm Saturdays and Sundays, followed by 6:30pm-8:00pm on weekdays.
By using innovative information technology general practice will be working in a collaborative, joined-up way to support the implementation of the latest in modern approaches to patient access, such as video consultations and self-care smart phone applications.
The new service will be operated from four key hubs across West Essex and will see local general practice teams working together to manage patients with acute exacerbations of chronic disease and those otherwise at risk of unplanned admissions. These services went live in October 2015 will be fully implemented by 21 November 2015.
33. West Midlands Primary Care Workforce and Improved Patient Access Plan
This scheme covers 37 practices and serves a patient population of 350,000 across Stafford and Surrounds, Telford and Wrekin and Shropshire County. It will provide the workforce and technology necessary to develop and deliver those services required to meet a significant proportion of primary care demand on the NHS locally, now and in the future.
This scheme will offer extended access over five localities which went live in September, providing weekday appointments 8:00am-9:00pm and weekends 9:00am to 9:00pm. On a pre-bookable basis, the project offers 109,000 additional appointments from a range of appropriate clinicians and 40,000 additional physiotherapy telephone triage and treatment appointments.
Acute Visiting services will be established and expanded to rapidly meet the needs of our most vulnerable patients. Referrals will flow through a Care Coordination Centre which will manage acute requests into acute trusts, ambulatory emergency care pathways, step up care, acute diagnostics, access to senior clinical opinion, community and social services.
Workforce is a critical element and therefore forms a significant part of the proposal. Partners will work collaboratively and innovatively regarding all aspects of employment, delivering economies of scale through a number of organisations. The project involves local training resources including practices, OOH provider, universities and Health Education England, drawing on existing courses with additional refinement to meet primary care needs, plus an innovative curriculum design for gaps in training. Specific elements include dementia and frailty, urgent care and mental health.
The third major element of the plan is the implementation of clinical record sharing between service providers to allow seamless patient care. Further IT developments include virtual consultation via online portals and recording of biometric data by patients/clinicians, which went live in October 2015.
34. Working Together to Transform Primary Care in Ipswich
The scheme in Ipswich will offer patients from 66 practices with 630,000 registered patients, improved access to appointments in the evenings and weekends from 6.30pm-9.00pm Monday to Friday, and 8am-8pm Saturday, Sunday and bank holidays.
An evening and weekend primary care ‘super-hub’ launched in September, located in Ipswich, and a smaller hub in Bury St Edmunds will launch in November 2015. The hub will provide additional primary care capacity, particularly to the deprived and rapidly growing communities where GP practices face sustainability challenges. The learning from this service will directly feed into plans to make practices across Suffolk more sustainable and into detailed planning by CCGs for urgent care across the county.
The initiative also includes various schemes to develop our primary care workforce and make working in Suffolk more attractive.
35. Multispecialty Community Provider Pilot in Worthing and Adur
Access to primary care services in this scheme began in September 2015, with appointments available to patients from 8:00am–8:00pm on Mondays to Fridays and by appointment between 10:00am–2:00pm on a Saturday and Sunday. Patients will be able to access services at four sites, and a range of appointment types will be provided. This includes urgent appointments, pre-bookable routine appointments and a walk-in service for children from 4:00pm–8:00pm at one of the sites. The new local multispecialty clinics will work in collaboration with a Medicines Management Pharmacist.
Additional services planned include the development a team of health professionals to provide support to housebound patients with long term conditions, and for frail elderly patients to receive additional support from pharmacists in regards to their medication. In September the scheme began a patient texting services in 14 practices, which aims to remind patients of their appointments.
Overall, this scheme covers 19 practices and a patient population of 163,004.
36. Together for the health of Halton
This scheme of 17 practices and 128,620 patients focusses on four main elements: extending access and points of access; supporting and empowering patients to make appropriate choices in accessing care; co-production of the new model of care with local people, partners and providers; and implementation of the new care model.
It will bring tangible benefits to the local population with extended access services already being delivered and alternative access routes in place, including a new e-consultation system which went live in August 2015. In October 215, local pharmacies expanded the range of services they provide to offer alternative access points and improve the quality of care delivered.
A range of local partners, including the voluntary sector, community provider, Widnes Vikings rugby team and the Public Health team, are delivering a series of community based services that will reduce demand on the local general practice service by supporting and empowering patients to make appropriate choices in accessing care.
A borough-wide communications and marketing exercise has been aligned, aiming to promote the full range of services being delivered, as well as provide a coordinated series of educational and awareness raising messages that further support the self-care agenda for local people living with different long term conditions.
37. Transforming Primary Care in South Cheshire and Vale Royal
This scheme will deliver five interlinked elements of service for nearly 224,000 patients across 23 practices and four localities using a phased approach that will be complete by 31 October 2015. The philosophy is to deliver extended opening and improved access through: existing practices, existing staff, with minimum spend.
Improved access went live initially in July 2015, with the remaining practices offering this service going live in September 2015. Improved access is now available between 7.00am-8.00pm on Mondays to Fridays, 9.00am-2.00pm Saturdays and 10.00am-2.00pm on Sundays, creating an additional 2000 extra appointments over the coming year.
The above improved access will be supported by an IT innovation workstream looking at utilising technology and other innovations to provide better patient care and access to services.
The last element of the scheme is the development of a new ‘Alternative Solutions’ service that supports practices in addressing the social determinants of ill health, along with the running of a marketing campaign called ‘open for you’ which promotes the new ways of working.