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GP practices to stop same-day care as ICS effectively mandates new service

Exclusive The third-largest integrated care system (ICS) in England is effectively mandating the use of ‘same-day access hubs’, leaving GP practices with only ‘complex’ patient care. 

From April, North West London integrated care board (ICB) is introducing the requirement as part of its ‘single offer’ local enhanced service, with practices obliged to sign up to all services to access the funding – effectively mandating the hubs.

The same-day access (SDA) hub model will ‘deliver a single point of triage for same-day, low complexity’ demand for all patients in the ICS, and has already been trialled with ten PCNs in the area. 

In documents seen by Pulse, the ICB has said it is ‘now a priority to support the remaining 35 PCNs’ to also implement the model so that there is ‘an equitable offer to patients across NW London’.

The ICB has commissioned management consultancy KPMG to help practices make the transition over the coming weeks.

Single or groups of PCNs can come together to form the hubs, which will be located at one of the participating practices or at suitable alternative premises. 

They will be staffed with a multidisciplinary team consisting of ARRS staff from practices and as well as at least one GP who will hold overall clinical accountability. 

An example of staffing, provided by NWL ICB, included one care coordinator to manage triage, one senior supervising GP, three prescribing ANPs or PAs, one pharmacist and one social prescriber. 

Patients will be directed to the hub if they select ‘same day’ when phoning their GP practice, after which the care coordinator, with support of the GP, will assess whether the patient requires same-day care.

The ICB’s plan stipulates that practices and hubs must have shared record access so that if required, staff at the hub can book a patient directly back into the GP practice appointment list. 

In its letter to clinical directors, the ICB said there is a ‘recognised issue with capacity across the NHS’ and all parts of the system ‘need to re-think the way they work’.

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Local health leaders wrote: ‘Building on everything it has already achieved through working together at scale, NWL is asking practices to prioritise working with their colleagues (at PCN or borough-level, as determined appropriate) to scale up any total triage practice-based models they have in place, to deliver a single point of triage for a same day, low complexity access model, at scale.

‘This should be done with a view to addressing the balance of provision so that there is greater parity between a place’s ability to deliver reactive, same day care on the one hand, and manage preventative, proactive, complex care, on the other.’

In its assessment of the current state of general practice, the ICB said some practices are ‘still operating a first come first served approach to appointments’ and ‘switch their phone to answerphone when their on-the day lists are full’.

‘Enhanced access is not being fully executed or utilised: some practices are not delivering on the contractual requirements to deliver enhanced access. Efficiencies are limited due to poor interoperability and access to diagnostics,’ the report added. 

This year’s GP contract included an obligation for practices to offer patients an assessment or signpost them to other services on first contact, meaning they can no longer ask patients to call back another time. 

In January, Pulse reported that NWL ICB, among others, had paid for management consultants to help design GP strategies and improve access.

The local commissioner has built on this work with KPMG to develop a model which will form the basis of a specification for the ‘Enhanced Services single offer’, to be launched from April.

Unlike other specifications in the single offer, such as hypertension or coil fitting, the funding will not be allocated to PCNs based on activity, but rather to support practices to ‘transform the way they work’.

Over the next two months, GP practices are expected to work with KPMG to design their same day access hubs, and are expected to use existing access funding through the IIF and QOF to support this. 

Pulse has contacted NWL ICB for comment.

In November, LMC leaders emphatically rejected the notion of separating acute on-the-day care from planned general practice care. 

Last year, the Fuller stocktake – a landmark review on how to integrate primary care with other NHS services – recommended that urgent same-day appointments should be dealt with by ‘single, urgent care teams’ across larger populations rather than the patient’s own GP practice.

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