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Improving access to general practice and reducing A&E attendance by almost 50% – a local perspective

5 July 2017 | Dr Kevin Barrett

Dr Kevin Barrett, GP Partner at New Road Surgery and Chair of the Watford & Three Rivers Locality explains the impact and learning points of improving access to general practice.

Background

In October 2013, the Prime Minister announced a £50 million Challenge Fund to improve patients’ access to general practice.  Watford Care Alliance was one of 20 pilot sites selected, covering 1,100 general practices and 7.5 million patients across the country. Our pilot site, using an existing GP provider company, Direct Local Health, as contract host, covers a population of 114,000 patients from 12 out of 26 practices across the Watford and Three Rivers locality of Herts Valleys CCG[1].

Watford Care Alliance

Our approach was to work collaboratively to set up extra clinics at times that better suited patients with the aim of reducing the pressure on local A&E and urgent care centres.

Funding was available from April 2014, and we were able to get things up and running quickly with the first patients being seen in July 2014. Two locations were used, one fixed and one that rotated around the remaining 11 practices. Patients could pre-book GP appointments in either hub from 6.30-8pm Monday to Fridays, and GP and phlebotomy appointments from 9-1pm and 3-7pm on Saturdays and Sundays. Demand for Sunday afternoon appointments was low and these were discontinued.

Technology

Three different clinical systems (EMIS Web, SystmOne and Vision) were in use in 2014. Read-only access to all systems was enabled in each practice and Adastra was chosen for clinical entries as this was used by the out-of-hours provider.

Impact Analysis

In the evaluation, 13 of the 20 pilots have shown a combined 17% reduction (44,400) in minor self-presenting A&E attendances in patients from practices taking part in the schemes, with the highest reduction of 47% for patients from the 12 practices in Watford[2]. This is a major achievement and is a testament to the teams of people who have worked so hard to make this happen.

Watford Extended Access

 Herts Valleys CCG offered practices an enhanced payment to improve access to primary care for three years from 2014-2017. The Watford and Three Rivers locality provided additional appointments targeted at patients who were more frequent attenders at A&E, e.g. the under-5s presenting after school hours.

As the enhanced payment was due to end the locality leadership team and Watford Care Alliance agreed to expand the scheme to cover all 26 practices and 209,000 patients in Watford & Three Rivers. Practices voted to pool a third of the payment and in October 2016 an additional three hubs were opened. There were two IT systems left in the locality that allowed real-time data sharing between practices. It was not yet possible to allow access between different systems, so patients from the 4 practices using SystmOne can only book into one hub, but patients from those practices using EMIS Web have the choice of 4 locations each weekend.

In April 2017, the scheme was renamed Watford Extended Access and is now funded via the General Practice Forward View Transformational Support[3]. It is hoped to locate a hub near A&E at Watford General Hospital as part of the national streaming requirement.

Key Learning Points

  • Effective leadership and project management were central to the successful implementation of the pilot, and specific individuals were pivotal in gaining local buy-in. The rapid start-up happened as a primary care provider organisation was already in existence.
  • IT is a key enabler in making collaborative working happen. Real-time access to full patient records means that the indemnity companies do not apply a premium rate.
  • Collaborative working between practices has led to a sharing of expertise and resources more freely than before, and patients can now access an increasing range of services from practices other than their own, such as joint injections, minor surgery and ambulatory blood pressure monitoring

[1] www.england.nhs.uk/wp-content/uploads/2015/10/pmcf-wv-one-eval-report.pdf

[2] www.england.nhs.uk/wp-content/uploads/2016/10/gp-access-fund-nat-eval-wave1-sml.pdf

[3] https://www.england.nhs.uk/wp-content/uploads/2016/09/NHS-operational-planning-guidance-201617-201819.pdf