The Folkestone, Hythe and Rural PCN hub pilot project was established at the end of the COVID-19 pandemic to develop a federated approach to online consultations and create more efficient ways of delivering extended and improved access appointments.  

This included:

• offering a single sign on process and the ability to consult from one clinical system to reduce the number of accounts that PCN staff had to use.
• providing capability for cross-organisational tasking and shared access to service appointment books hosted centrally.
• developing more efficient referral pathways and opportunities for better caseload management.
• building a data strategy to support understanding of PCN service utilisation, meet contractual reporting needs and enable population health management.

Drawing on ARRS and other PCN funding streams, the PCN created a small team of Advanced Nurse Practitioners and Care Co-ordinators to handle the 4,500 online consultation returns generated across its seven practices every month. It also worked with system suppliers to redevelop clinical IT systems to help its growing team of clinical and administrative staff manage demand and workflow across practice boundaries.

The hub model now supports a full range of PCN-delivered services including its Minor Illness Service, other Enhanced Access provision and additional enhanced services, specialist services run by ARRS-funded PCN staff, and Multi-Disciplinary Team (MDT) Coordination functions, all of which are hosted and served by a seamless digital platform.

As well as enabling PCN teams to collaborate at scale, the technical solution is capturing a rich array of data, which is helping the PCN to make the best use of available resources and improve its approach to population health management. The model is also helping the PCN to efficiently manage the contracts that it is required to deliver.

Outcomes and benefits

The hub’s operating model has already delivered a host of benefits to the PCN’s patients, workforce, and local GP practices:

Building capacity – the hub processes around 4,500 online consultations per month and provides over 2,200 additional face-to-face appointments for patients. This includes both the minor illness appointments delivered by the hub’s nurse practitioners and other services provided by the PCN’s ARRS-funded clinicians.

Freeing up resources – initial feedback shows that the efficiencies generated by operating at scale have released both administrative and clinical resources at practice level, which can then be reinvested in supporting patients with more complex needs. An independent evaluation is currently underway to understand the full impact.

Supporting delivery – a total of 12 different services now operate out of the hub, helping the PCN to deliver against a range of service requirements set out in the 2023/24 GP Contract. It also allows the PCN to rapidly stand-up additional capacity as needed (e.g. winter access appointments, CAS, acute respiratory infection, etc).

Enhancing business intelligence – the technical solution provides extensive management information including demand/capacity modelling, utilisation tools, monitoring of eHub activity and the automated tracking of new requirement for Access funding, GP contractual requirements, QOF and IIF data.

“As in many parts of the country, demand on our primary care services outstrips capacity, so it is important we make the best use of resources and embrace new models of care. The Folkestone, Hythe and Rural model rightly serves as a blueprint for modern general practice and is a credit to the leadership within the PCN and all staff working within in it.”

Sukh Singh, Director of Primary Care, NHS Kent and Medway

Next section: How the hub model operates