The twenty successful pilots are outlined below:
- Better Access, Better Care, Better Standards – Barking & Dagenham and Havering and Redbridge (North East London)
- Bury Easy GP Project (Greater Manchester)
- Caring for Darlington Beyond Tomorrow (Darlington, Durham and Tees)
- Cooperative in Bristol and South Gloucestershire (Bristol, North Somerset, Somerset and South Gloucestershire)
- Extended Primary Care Access in Southwark (South London)
- Extended Primary Integrated Care (EPIC) Brighton & Hove practices (Surrey and Sussex)
- Health United Birmingham (Birmingham, Solihull and Black Country)
- Improving Access, Supporting Primary Care Integrated Whole System Change – Taurus Healthcare Ltd (Arden, Herefordshire and Worcestershire)
- Integrated Primary Care Access across Devon, Cornwall and Isles of Scilly (Devon, Cornwall and Isles of Scilly)
- Integrated South Kent Coast (Kent and Medway)
- Opening Doors – Aligning and Integrating health and Care Services in Morecambe (Lancashire)
- Slough Steps to the Future (Thames Valley)
- Transforming the access experience at scale across England (The Care UK Superpractice)
- The Primary Care Home, Warrington (Cheshire, Warrington and Wirral)
- Together as One Community (North Yorkshire and Humber)
- Transformational Innovations for Primary Care in West Hertfordshire – Watford Care Alliance (Hertfordshire and South Midlands)
- Transforming Access to General Practice -General Practices across North West London (North West London)
- Transforming General Practice in Derbyshire and Nottinghamshire (Derbyshire and Nottinghamshire)
- West Wakefield – Moving Primary Care to a Population Wellbeing Approach (West Yorkshire)
- Workington Better Together – Developing Primary Care Communities in Cumbria (Cumbria, Northumberland, Tyne and Wear)
GPs in Barking and Dagenham, Havering and Redbridge have now launched three new access ‘hubs’ providing more than 700,000 patients with the opportunity to see a GP in the evenings between 6.30pm and 10pm without having to wait until the next day. Phase two of the project now sees urgent appointments made available via other routes such as a patient’s own GP, urgent care centres, walk-in centres and A&E where appropriate, and weekend appointments on Saturday afternoons.
In addition, the GPs have worked with commissioners and providers across the local health economy to set up a complex care scheme called ‘Health 1000’ – a ‘practice’ that will eventually care for 1000 patients with multiple long term conditions in a new and innovative way by wrapping a multi-disciplinary team around them to deliver fully integrated and focused care on the individual needs of the patient. Health 1000 is now open and the first patients have registered and are receiving their care from the new team rather than their usual GP. This results in better, co-ordinated patient care with improved outcomes.
The aim of the Bury GP Federation pilot is to provide all patients with more choice, convenience and flexibility in accessing local GP services. Patients in Bury can now book GP appointments at evenings and weekends, 8am-8pm Monday-Friday, and 8am-6pm at weekends and bank holidays in five locations. All 30 GP Federation practices are working together to staff the service on a rotating schedule, with clinicians able to access all patients’ medical records. An additional 1,400 appointments per week are available to patients as a result of this service.
In addition, 30 GP practices in Bury are now routinely offering telephone consultations to 180,000 patients as an alternative to face-to-face appointments. The service provides another route for patients to gain medical advice from their GP in circumstances where they may not need to attend the surgery.
The pilot has also engaged a wide range of patients to understand what information they would find valuable when making choices about how, where and when to access GP services.
11 Practices in Darlington covering 107,000 patients are providing greater flexibility for patients accessing GP services on evenings and weekends.
An evening telephone advice service is available Monday – Friday 6:00pm – 10:00pm via NHS111 offering services to patients including telephone advice; ability to arrange face-face appointments at their registered GP; prepare prescriptions to collect at their practice; and arrange appointments at the Urgent Care Centre in needed.
There is now greater opportunity to access primary care for all practices outside of core opening times, face-to-face GP appointments are available on a Saturday and Sunday from 8am to 2pm, delivered from a central site for all patients registered with a Darlington practice. Additional appointments are available during core opening times for three practices via an overflow clinic to increase availability. The weekend clinics continue to increase in popularity both pre-booked and on the day access from the urgent care centre and it now accepts calls from the community matrons for advice during the clinics to support the frail elderly at home.
The care planning of the frail elderly population is supported by a multi-disciplinary specialist team of GPs, nursing and social care staff, providing additional support for the frail, older patients providing care closer to home. We plan to support this further by funding a GP to be part of the Multi Disciplinary Team on a Sunday to help facilitate care both as inpatient and help with discharging and ensuring appropriate follow up.
One Care Consortium is a collaboration between 24 GP practices across Bristol, North Somerset and South Gloucestershire (BNSSG) and two local GP-led provider organisations, GP Care and BrisDoc. One Care’s vision is to create an integrated and effective approach to the delivery of primary care across BNSSG, providing seamless seven-day care to patients. This is being achieved through the sharing of standards, ideas, processes and resources; and the interface between General Practices and the Out of Hours service will be improved through the sharing of patients’ records.
The benefits for patients include efficiently managed weekend appointment booking for those with a specific clinical need, and prompt weekday access to practices via the telephone and the web, providing prompt and consistent response to calls, appointment scheduling, healthcare advice and prescription requests.
Improved clinical outcomes will be gained through the sharing of information and records between healthcare professionals, reducing the need for manual transfer of information.
The work of One Care Consortium will initially benefit more than 250,000 patients in the local area.
A community navigator scheme has been launched across 16 practices in Brighton and Hove, for patients who may be isolated or lonely and would benefit from connecting to services within their community rather than purely medical care. Working with voluntary care organisations, Age UK and Impetus, trained community navigators are providing support for patients with complex needs in community settings, particularly those who are living on their own. They are helping to signpost individuals to third and voluntary sector organisations, and other local resources, to meet their needs. Community Navigators have seen 38 clients via 85 Navigation one hour sessions.
The practices are working with local pharmacies and have created four ‘primary care clusters’, covering over 125,000 patients, to give patients a more responsive and flexible service. This includes same-day appointments, from 8.00am to 8.00pm, Monday to Friday and 8.00am – 2.00pm on Saturday and Sundays, either at a GP practice, in a pharmacy, or at home. Pharmacists have access to the patient’s medical record, to ensure they can carry out effective consultations. The practices are looking at how they can make better use of telephone consultations to meet people’s needs, as well as using web tools to increase information and access.
The Fund is supporting 44 practices covering 305,000 patients to provide better access to primary care services to the population of Southwark; offering additional levels of access from 8am-8pm, 7 days a week via new ‘Extended Primary Care Service hubs’ delivered by neighbourhood groups of practices. Practices engaged and co-designed the service model with patient input – the pilot heard what patients told them was important and incorporated this into their service models and patient experience surveys.
The pilot has implemented record and appointment sharing across the patch. This system has enabled the sharing of clinical information between general practice clinicians and the access clinic sites with patient’s consent. The outcome for patients is greater continuity of care and ongoing management of their condition.
In Birmingham, three practices covering 60,000 patients are offering extended access during the day, including more ways to access services (eg via video conference call) and more rapid telephone call handling and clinical call back and/or same-day appointments.
In September 2014, the pilot launched a new clinical contact centre in Handsworth, Birmingham, providing both remote and physical access to members of the public. This service provides both on-line (via a new web portal, smartphone app and call centre) and physical (via new consulting rooms) access to patients requiring same-day treatment and healthcare advice.
This pilot has launched an interoperable digital environment for patients and staff to support access and Long Term Conditions management. This offers web and app access as well as care management tools and video guides. The result has been increased clinical capacity to see more patients, with patients becoming more empowered and having access which is more convenient for them.
65 percent of patients are consistently being dealt with remotely without having to go in to practice. This has resulted in a reduction of 72 percent in DNAs.
Practices in Herefordshire are offering patients greater access to GP Primary Care services at existing practices from three new centres at 8am to 8pm, seven days a week, 365 days of the year. This pilot covers all 24 practices, with a patient population of 185,000, providing an additional 90,000 appointments per year, either by phone, e-consult, video link or face-to-face. The centres are also offering new services for the local hospital and care homes. A&E, Walk-in Centre and NHS111 staff can book appointments directly for those patients that need primary care support, whilst care home staff can access the primary care team at weekends by video link to provide care and support for their residents.
New community initiatives include training for carers of dementia patients, for example spotting the early signs of illnesses; general primary care health advice and referral surgeries for young people in two schools and a sixth form college; and access to a Heath App that gives patients health advice and information, and will enable direct patient booking for out of hours GP appointments.
The pilots’ 230 practices in Devon, Cornwall and the Isles of Scilly aim to deliver sustainable change to the 1,670,000 patients it covers.
In Cornwall, pilot funding has supported the development of GP led urgent care centres and nurse led minor illness treatment expanding the roles of community hospital MIU’s and providing local extended access from 11.00am-7.00pm (UCC) and/or 8.00am-8.00pm (nurse led treatment) 7 days a week for patients from 43 practices (328,000 population).
NEW Devon CCG runs a four site bookable and urgent appointment service from 10.00am-5.00pm each Saturday and Sunday via its Out-of-Hours provider (123 practices /863,000 population). One federation (16 practices/150,000 population) is providing a weekend extended hours service (8.00-6.00 pm) and a second (22 practices/163,000 population) offers bookable appointments – 6.00pm/ 8.00pm Monday to Friday – these can access patients’ notes.
Schemes in South Devon and Torbay test three different models of case managing frail elderly patients with the intention to reduce unplanned admissions and improve quality of care. The CCG has also focussed on maximising the benefits from using technology including supporting self-care through use of health hubs and information sharing points at all of its 37 practices (285,000 population).
Four initiatives increasing access to pharmacy are popular with patients.
This pilot brings together 18 practices offering extended and more flexible access to services for 110,000 patients based around a hub in a local hospital. Patients registered at of the 9 of these practices have been able to book appointments from 8am to 8pm, seven days a week from 1 October 2014, and the remaining 9 will be able to do so from 23 March 2015.
This pilot continues to receive positive patient feedback regarding the paramedic practitioner (PP) visiting service which has been implemented; these PPs work with the practices and the NHS111 service to visit acutely ill patients at home. They have access to GP clinical records and can see and treat patients in collaboration with the patient’s GP to avoid admissions or a transfer to A&E. All 18 pilot practices refer patients for urgent visits Monday to Friday.
For patients with urgent mental health needs, this pilot is also introducing a new rapid assessment service delivered by a primary care mental health specialist, either at a patient’s home, at their GP practice or hub which will start in the next few months.
The five practices in this pilot are working collaboratively to deliver GP extended access services 8am to 8pm 7 days per week. The service operates from a single hub and utilises the existing workforce to provide GP and Nurse Practitioner cover to provide pre bookable appointments for patients who find it difficult to access their GP.
This pilot offers an ambulance support service which makes provision for a GP to be available for ambulance crews to support the decision making process on site. Crews now have the option to speak directly to a GP with full access to patient notes prior to conveying them into an acute. After discussing the presentation of the patient and referring to clinical history over 95 percent of patients are referred back into primary care and therefore not admitted.
Another strand to the project is the promotion of the self-care agenda, and the project is focusing on two areas to support this. The roll out of the tele-health service Florence is proving very popular with patients as it allows them to take greater control of the management of a number of conditions without the need to attend the practice.
A further workstream is the introduction of a minor ailments scheme which is being delivered in conjunction with local pharmacies, this scheme encourages patients to make greater use of the pharmacies by collecting over the counter medicines free of charge (subject to a consultation). This is already starting to impact on the availability of appointments as patients no longer need to see a GP first for treatment.
The project in Slough was built on insights from patients about primary care and what they believed was needed to improve access and to help them keep well. It was co-designed by patients with their GPs and practices.
GPs in Slough have been offering 8am to 8pm extended hours on weekdays since July 2014 and on weekends since August 2014 (9am-5pm Saturday and Sunday) for over 148,000 patients. To date patients have expressed in excess of 98 percent satisfaction with their experience of the new service.
Alongside extended access, patients can subscribe to receive free texts to promote wellbeing, as well as get reminders about routine health checks. Patients with complex needs or unstable conditions are offered a direct line to the clinician with whom they work most closely.
Slough GPs are working with their patients to review the words that are used in consultations to ensure that patients can understand and get the most out of their appointment.
Patient Navigators are being piloted through work with the local voluntary services to help people make the best use of local information that is already available to help them keep well.
Two practices in North Colchester and Clapham Junction are offering 12,000 patients the facility to access services by phone 24/7, using a single point of contact. Patients can call their practice and talk to a GP or nurse with full read-write access to their medical records who can provide diagnosis, treatment, handle routine queries, arrange prescriptions and signpost them to the right treatment or service that best meets their health needs. This has resulted in 94 percent patient satisfaction with the service.
An online tool allows patients to manage minor illnesses and injuries themselves, within the community or submit an e-consultation to their registered GP.
The Warrington pilot, covering 28 practices, is looking at maximising the potential of the GP registered list to integrate care and to enable working beyond the practice walls. The pilot is offering extended access with appointments running 8am to 8pm weekdays, with weekend appointments available also.
The innovative approaches this pilot is taking will benefit 208,000 patients registered in the pilot’s practices – to provide more integrated health and social care services, closer to patients’ homes, forming the basis for whole system change. Every ‘Primary Care Home’ organisation is benefitting from shared services across practices, including care coordination, guided care, care home Multi Disciplinary Team approach.
This pilot is offering patients extended opening hours – 8am to 8pm, seven days a week via hubs.
There is a new focus on preventative care and care planning which will help to transform GP services in this North Yorkshire pilot, covering 21 practices and benefiting 142,385 patients. Patients with LTCs are gaining increased ownership of their care.
Video technology will enable specialist clinicians to offer ‘virtual’ appointments at the patient’s own GP surgery, to provide a seamless service, delivered locally, across hospital and primary care.
In West Hertfordshire, 115,000 patients across 15 practices can access GP appointments up to 8pm, seven days a week, giving an additional 12,000 GP appointments a year.
The additional appointments are enhanced by the provision of a weekend Phlebotomy service, offering patients extended access to blood tests and reducing pressure on regular GP services. Patients from the 14 pilot practices can book in for this with a nurse or Healthcare Assistant which relieves pressure on GP appointment slots. There has been a good take up of appointments, with high patient satisfaction.
Patient survey results show that some patients are choosing to access the additional Challenge Fund appointments rather than attending A&E with 16 percent of respondents stating that without the availability of an extended hours appointment they would otherwise have attended A&E.
Patients can now benefit from an enhanced multi-disciplinary Integrated Health and Social Care team – the pilot brings a specialist palliative care nurse, an overnight hospice at home service and lead GP to work alongside a social worker, community nurse, physiotherapist and occupational therapist.
In North West London, GP practices are coming together to deliver services as provider networks. This is improving access to primary care for patients across eight CCGs.
Over 1.4m patients are already benefiting from extended access provided by almost 300 GP practices working together in provider networks. Network working has scaled up the number of patients able to benefit, through such initiatives as extended access hubs. By the end of March 2015, our expectation is that 2.1m residents will be able to benefit from improved access.
Many practices are making strides towards providing access to telephone appointments and some are offering email and video conferencing appointments as well as electronic prescriptions and online records access for patients that want it.
This pilot offers benefits to 1.2 million patients from 150 practices.
The pilot offers extended hours in centrally located hubs, seven days a week; patients access services via hubs in the area. There are new ways to access consultations: by phone, email, video; and telecare to help people to better manage conditions at home.
By offering a call back service from a clinician, patients are getting fast access to care. In one practice this is saving up to 400 face to face appointments per week, with feedback from patients reporting this is a better service.
Over 100 of the most common conditions are detailed on the practice website. Patients better understand their own condition and are empowered to be proactive about their managing their own care.
Advanced Nurse Practitioners and a Care Coordinator are proactively targeting patients in the top 50 percent of care homes with respect to avoidable hospital admissions and attendances. Proactive ward rounds include formulation of care plans for individual patients, and updates from these are fed back to patients’ GP.
Six GP surgeries in Wakefield are working together to make services more accessible in practices and across the community. The practices 63,000 patients now benefit from longer opening hours, from 8am to 8pm seven days a week operated from a central hub premises. The pilot has introduced a new service directory giving patients better access to community based services as part of a wider on-line care navigation system.
Video consultations and electronic messaging are in the process of being launched as well as ‘real time’ web chats and phone consultations with a care navigator.
In recognition of at least 20 percent of new problems presented to GPs are minor musculoskeletal problems, the pilot set out to test whether experienced physiotherapists can deal with these presentations effectively instead of a GP. All six pilot Practices now have access to this ‘Physio First’ service offering appointments with a frontline physiotherapist. Patient feedback has been excellent with high satisfaction reported, and low rates of return to the GP.
Patient records will be shared with care homes which will host video consultations and virtual consultant ward rounds. A new pharmacy co-ordinator is working across the practices to promote integration with community pharmacy and self-care for minor ailments.
The pilot involves all five practices across the town coming together to operate as a single organisation providing modernised primary care services for the Workington population of 33,292 patients. The team has redesigned the minor injury service into a Primary Care Centre offering same day appointments to enable timely access to primary care and is open 8am-8pm, 7 days a week. The management of appointments within practices has also been reviewed, releasing capacity to focus on primary prevention and to support the care of frail elderly patients with long term conditions.
Other initiatives which have been introduced as part of the pilot include a specialist nurse practitioner post to enhance care and care planning in residential homes, and the development of specialist diabetes and COPD clinics in primary care.
Since October 2014, the Primary Care Centre has seen more than 14,000 patients with both patients and staff recording high satisfaction levels with the service.