Agenda item

To receive an update on upcoming national changes to ‘enhanced access’ to general practice – the additional provision of appointments outside of core hours.

Clare Henderson, Director of Integration in Islington at the NCL ICB, introduced the report for this item by explaining the changes that would result from the proposals on enhanced access to General Practice from October. This related to access to services outside of the core hours which were 8:00am to 6:30pm on Mondays to Fridays. At present, the enhanced access hours were offered at ‘hubs’ from 6:30pm to 8:00pm on Mondays to Fridays and 8:00am to 8:00pm at weekends or bank holidays. This was part of a national specification and the services were generally provided in the NCL area through GP Federations or other primary care providers. Some GP practices also offered ‘extended hours’ which involved longer opening hours funded through a contract.

The new proposals involved bringing these two types of services outside of the core hours into one single specification delivered through Primary Care Networks (PCNs). The timescales for implementation had been tight with the national specification released in March 2022, draft plans to be developed by PCNs by the end of July and the delivery of the new service by the beginning of October 2022. The new national specification required the additional opening hours from 6:30pm to 8:00pm on Mondays to Fridays but only from 9:00am to 5:00pm on Saturdays with no requirement for services on Sundays or Bank Holidays. There was also no longer a requirement for ring-fenced slots for NHS 111 to book into.

In the NCL area there had therefore been engagement with PCNs with a view to commissioning services on Sundays and Bank Holidays so as not to lose the 7-day access. Engagement had been based on existing patient feedback and from HealthWatch and partners in the voluntary and community sector. A survey had also been developed to support PCN engagement. However, due to the timescales, it had not been a long engagement process and the scope had been limited. An Equality Impact Assessment had been developed and, while it was expected that there would be additional capacity overall, it was also recognised that there was a high level of demand on services at present.

Clare Henderson then responded to questions from the Committee and was joined by John McGrath, a GP in Islington and interim Clinical Lead on the ICB:

• Referred to the proposals to buy provision of services in the NCL area from outside of the hours required by the national recommendations, Cllr Connor queried whether this would involve new providers and, if so, how the service provision would be monitored. Clare Henderson clarified that the new national specification required broadly the same number of appointments but in a shorter timescale within the week. Therefore, by buying the Sundays and Bank Holidays services within the NCL area, there would be no loss of capacity. The arrangements would be for PCNs to ensure the delivery of services and some would work with the same GP Federations that provided the existing services.
• Cllr Connor expressed concerns that, if new providers for enhanced access could not be found, then there could be a risk of A&E departments becoming overwhelmed as patients sought treatment there when they could not access GPs. Clare Henderson explained that from October to March the existing providers were being asked if they could provide a bridging service during this phase to ensure that urgent same day services remained available.
• Cllr Cohen asked about the approach to making a range of specialist services, such as physiotherapists or pharmacists, more widely available in order to reduce the need for patients to see their GP. Clare Henderson said that practice-based pharmacists had been well established in recent years and, while patients may not necessarily ask to see a pharmacist when ringing the practice, the triage system should direct them towards this where appropriate. There was an intention to expand this approach to other types of services including physiotherapists.
• Cllr Revah queried how patients would know that they could obtain GP appointments via the NHS 111 service. Clare Henderson clarified that patients would not need to know this as they could not simply ring NHS 111 and ask for an appointment, but the triage system would allow for a booking to be made if the described symptoms made this the most appropriate option.
• Asked by Cllr Revah about the shift towards phone or online appointments, Clare Henderson said that while these options were now more widely available, all practices would still offer face-to-face appointments if clinically needed.
• Cllr Bevan expressed doubts about the need to provide services on Sundays and Bank Holidays given the cost implications of doing so and suggested that it would be better to stick to the national specification. Cllr Cohen also asked about the cost implications. John McGrath observed that the frustration about this policy in London was that there were already services available outside of the core hours but that this was an enforced change. He welcomed the comments opposing Sunday and Bank Holiday service hours as it needed to be acknowledged that the service was in real peril due to a workforce crisis and financial difficulties. Overall, the focus of the national specification on service provision on Saturdays from 9:00am to 5:00pm prioritised continuity of care rather than same day access, which he considered to be a good thing while acknowledging the balance that needed to be struck. He also acknowledged that there were cost pressures associated with this change but did not have specific figures available. Cllr Revah requested that further information be provided to the Committee on the financial implications of the changes. (ACTION)
• Cllr Hutton emphasised the importance of communicating to the public about the services that were available to them, including Urgent Care Centres. John McGrath acknowledged that there was also a real challenge concerning public knowledge about the variety of services that were available and that this would need to be addressed by social care, Council and voluntary sector colleagues as well as the NHS. He added that the public may not notice the changes to enhanced access to GP practices very much at all as the aim was to ensure that services outside of core hours would continue.
• Cllr Bevan asked whether any national publicity was planned to promote public awareness of these services. John McGrath said that he was not aware of any planned national publicity but that local areas were being provided with resources/capability to do this and that NHS 111 was increasingly being recognised as an entry point to services.

Cllr Connor observed that when patients called GP practices but no appointments were available, they were not then typically signposted to the hub services and this therefore kept the pressure within the practice.

The Committee recommended that the availability of hub services, or any other appropriate services, should be more clearly communicated by GP practices at this stage. This should include wider dissemination of information about alternative service provision to the GP practice staff that deal with patient appointments.

The Committee also recommended that, with regards to the proposed bridging service running from October to March, the number of patients likely to use this service should be carefully considered. If these figures were low then it would not necessarily represent an efficient use of resources and so patients could otherwise be treated by different services. (ACTION)