National Review of Access

to General Practice Services

in England:
London and South East
regional event

Wednesday 18 September 2019

NHS England and NHS Improvement

 Welcome and introductions
Caroline Temmink,
Regional Head of Primary Care,
NHS England and NHS Improvement
- South East and South West

2 | National Review of Access to General Practice Services in England

 Housekeeping

3 | National Review of Access to General Practice Services in England

Agenda
Time Session
Welcome and introductions
10.30am Caroline Temmink, Regional Head of Primary Care, NHS England and NHS Improvement - South
East and South West
Overview of the access review
10.45am
John Taylor, Head of Improving Access to General Practice, NHS England and NHS Improvement

Feedback on access review and Q&A Panel

11.10am
John Taylor, Head of Improving Access to General Practice, NHS England and NHS Improvement

Southwark - clinical triage and patient experience

11.30am
Southwark CCG

East Berkshire CCG

12.00pm
Alexandra Tilley, Associate Director for Primary Care, East Berkshire CCG

12.15pm Lunch and networking

Table sessions: Please pick from three of the following sessions (45 minutes per session)
• Patient and staff satisfaction
• Digital
1.00pm • Reducing inequalities in access
• UEC
• Models of access
• Workforce

Feedback from sessions

3.15pm
All
Q&A session
3.30pm
All
4.00pmReview
4 | National Close
of Access to General Practice Services in England
 Overview of the national
Review of access to General
Practice services in England
John Taylor,
Head of Improving Access to General
Practice

5 | National Review of Access to General Practice Services in England

Why are we looking at access
to general practice?
• Patients views and needs are changing

• Level of investment in general practice not increased

• Morale and job satisfaction at its lowest since 2001

• General practice and primary care needed to change

• So, what are we trying to do….

6 | National Review of Access to General Practice Services in England

Timeliness of appointments
How long after initially trying to book the appointment did the
appointment take place?
32.8% 32.6%

26.5% 25.7% 25.3%

23.8%

Patient views
11.0% 10.4%
5.8% 6.0%

On the same day On the next day A few days later A week or more later Can’t remember

2018 2019

GP system data

7 |
 General Practice Access Fund
57 GP Access Fund schemes
17 telephone
consultation
schemes
Over 17m patients
25 online or web services

2,500 general practices 24 trialled

e-consultations
More than 300 14 integrated
access hubs created 9 schemes community
introduced care teams
care
navigation
More than
£285m invested 24 community pharmacy
and Pharmacy First
schemes

13 schemes
2 roving integrated
doctors with 111
16 self management
and LTC schemes
8 | National Review of Access to General Practice Services in England
 The access review
The access review has one main objective:

to improve patient access both in hours and at evenings and weekends and reduce
unwarranted variation in experience

Plus supporting tasks:

Engage Relationship
How to Best use of
Costs & with Understand between Comprehen
support appointme Care Make best
benefits of More patients workforce sive out of
patients & nts that navigation variations
current & joined up and use of
staff make off & demand in waiting pressure, hospital
previous services public& resources
best use of continuity mgmt times wellbeing & offer
models understand delivery
services and choice
inequalities

A key output

will be the development of a coherent access to general practice appointments offer that
practices (in hours) and PCNs (outside core general practice hours) will make for both physical
and digital services to 100% of patients
9 | National Review of Access to General Practice Services in England
Communication and engagement
The access review will:
• Ensure relevant audiences across general practice, primary care and the wider system
are aware of the national review of access to general practice, understand its
objectives, key outputs and scope.
• Offer patients and the public the opportunity to contribute their views and experiences.
• Enable key stakeholders, including general practice teams, commissioners, and
providers to engage with the review and provide feedback based on their own
experiences.
• Connect with key internal and external groups, as part of the National Advisory Group
and Working Group.
• Facilitate targeted engagement with specific groups who may have feedback to offer
regarding certain aspects of the review e.g. digital specialists and urgent care teams.
• Ensure any recommendations arising from the review are widely communicated and
understood, to aid implementation.
A number of regional and subject specific engagement events have been set up: details of each
event can be located here: www.england.nhs.uk/accessreview

10 | National Review of Access to General Practice Services in England

 How to keep in touch and further
information
• We have set up a dedicated email address for the review:
england.accessreview@nhs.net

• To read more about the review, please visit: www.england.nhs.uk/accessreview

• If you wish to attend any of our upcoming regional or subject focussed events,
please visit our webpage or email england.accessreview@nhs.net

• To read the “Investment and evolution: A five-year framework for GP contract

reform to implement The NHS Long Term Plan, please visit:
https://www.england.nhs.uk/publication/gp-contract-five-year-framework/

• Share your views or follow the conversation on Twitter using the hashtag
#gpaccessreview

11 | National Review of Access to General Practice Services in England

 Feedback on access review and
Q&A Panel

John Taylor, Head of Improving

Access to General Practice, NHS
England and NHS Improvement

12 | National Review of Access to General Practice Services in England

 Clinical Triage in Southwark

Dr Sian Howell, GP in Southwark and

Clinical Lead Access, Transforming
Primary Care Team, Healthy London
Partnership
Jean Young, Head of Primary Care
Commissioning, Southwark CCG

13 | National Review of Access to General Practice Services in England

Clinical Triage Southwark EPCS

Siân Howell, Southwark GP, Clinical Lead for General Practice

Access Health London Partnership
Jean Young, Head of Primary Care Commissioning, Southwark
CCG

September 2019
 Southwark
Drivers Aims Challenges Successes Next Steps
model
The future is already here — it's just not
very evenly distributed. Gibson

IKEA Effect: we value things more that

we make ourselves. Norton

Change happens at the speed of trust

Rominger
Southwark’s Population
Information Source: Annual Report of the Director of Public Health 2016 statistical bulletin.
Southwark Council: London, 2017

Young population, Resident population

319,270 registered median age in expected to increase
patients Southwark is 32.7 by 12% over 10
years years*

High ethnic diversity.

High population
Over 300 languages Densely populated * Does not
turnover include recent
spoken planning
proposals

Almost 40% of Southwark population Continued improvements

Southwark residents live turnover rate is 8th in overall health, but
in areas considered most highest among London health inequalities still
deprived nationally boroughs remain

Despite an overall increase in life expectancy a significant

deprivation and gender gap remains

17
 Drivers for change

2013
Patients in Southwark told us general practice
was not meeting their needs for access.

CCG developed Primary and Community Care

Strategy including:
Improved access for patient
More equitable service
Support for practices to work collaboratively as
an enabler for change
Working at scale

This led to:

Federations development –
Quay Health Solutions (QHS) in the north
Improving Health Limited (IHL) in the south
 The only one that really
embedded in Southwark
is the Federation
delivered EPCS service
PMCF Southwark Bid

EPCS
8-8 On-line
Integrated
7/7 consults
with OOH
Federation Hurley
delivered SELDOC
from Feb
Group
2014
Aims

Support practices to offer improved access to

patients throughout the day and from 8-8,
including weekends.
Scope – outline service model:
Service delivered through a seamless
neighbourhood service configuration

Telephone management by clinician

Rapid telephone management by senior clinician to support
robust demand management and balance the needs for
same day demands with the needs of patients who require
continuity of care for planned care needs.
Were aims achieved?

Yes
We have two fully functioning EPCS in
Southwark offering a range of services 8am-8pm,
7 days a week.
Over:
71,000 appointments annually
95% of respondents would be likely or very likely to
recommend the service
90% reported a good experience
90% said they found reception staff helpful
Model development

Developed by the practices Enablers:

Agreed key principles;
Better offer to patients
Linked and aligned to the practices
Supporting both improved access and
continuity
Support to the practices to improve
their access offer
Equity across the borough
Demand management
PMCF backfill to support
engagement
Supported by evidence
Underpinned by principles of the
Primary Care Strategy and the
agreed principles
Clinicians have access to patient
record

Senior Clinician telephone triage model Locally owned model

Utilisation April 18 – July 19

IHL QHS

88% 80%

Utilisation including DNA’s

Patient pathway
Challenges

New Speed of
CQC Leadership External scrutiny
organisations delivery

Variable use of
Quality issues Standard rates
WIC EPCS and Staffing
surfaced of pay
quality of triage

Practices not all

aligning with Non English Continuous
Aligning with 111 on the same
OOH speakers improvement
systems

Meeting
increased
Reducing costs
demand without
increasing cost
Successes

Over 95% of Can quickly and

patient would It works Leadership easily book
recommend appointments

Practices
Effective Underpinned
developed Convenient for
communication collaborative
effective tel patient
strategy working
triage

Foundation for Shared approach IT connections

Simple to use
federations to quality

People want
more
 Practice
manager Excellent and
EPCS triage is amazing rapid
‘We could not quick and service. Many
have managed helpful. thanks.
without EPCS’
GP Patient

GP

Gives patients a Quality of

much greater triage has
choice improved over
time

Patient GP GP

Thank you have A life saver in

been very well the winter
looked after months’ GP
Evaluation
• In 2016/17, NHS Southwark CCG commissioned Deloitte LLP to undertake an
independent evaluation of the EPCS to inform developments and ensure the service
fully delivers on commissioning objectives, including improving access to, and
reducing pressure on general practice. Key findings of the evaluation include:
• The EPCS was a new way of commissioning additional general practice
appointments. It required practices to change the way they worked, and the scale of
change was significant.
• Patients have had a positive experience with the EPCS; with consistently high levels
of patient satisfaction. Patients welcome the sharing of data between the
EPCS and the practice to support continuity of care. A snapshot patient survey also
found that many patients were not aware of the EPCS but would be interested in
using it.
• Practices also feel that the EPCS has helped their patient's access primary
care. From a staff survey undertaken by Deloitte, 87% of staff noted that the
EPCS has helped reduce demands on their practice.
• There is a high variation among practices in the utilisation of the EPCS; however,
utilisation, total referrals and capacity have increased over time.
• From interviews and case studies with practices, whether or not a patient is willing
to visit the EPCS depends on convenience and how the service is communicated to
them by the practice clinician.
What next?

General Wider
EPCS
practice system
Look at core hours
How to make
Manage reduced provision
general practice
funding envelope
the ‘go to’ place

Incentive/resource
Opportunities to
balance
PCN development
Apex/Edenbridge investment across
tool the ICS system
Thank you

sianhowell@nhs.net

jean.young4@nhs.net
 Improving Access to General
Practice in NHS East Berkshire
CCG

Alexandra Tilley, Associate Director

for Primary Care, East Berkshire
CCG

32 | National Review of Access to General Practice Services in England

 Improving Access to General
Practice in NHS East Berkshire CCG

Our Experience

Alex Tilley
September 2019

Working together to deliver excellent and sustainable healthcare

 East Berkshire CCG
• Member of the Frimley Health
and Care Integrated Care System
• East Berkshire: 464,200 registered
population
• Three Places: Slough, Windsor &
Maidenhead and Bracknell
• Three models of IAGP services –
delivered by three providers
across four delivery points
• Live since 2014 (Prime Ministers
Challenge Fund – Wave one site)
in Slough
• Out of Hospital Urgent Care
review

Working together to deliver excellent and sustainable healthcare

 Improving Access
Access review:
to improve patient access both in hours and at evenings and
weekends and reduce unwarranted variation in experience

Our commitment:
• provide patients with more convenient access to
general routine appointments
• additional appointments also to help relieve pressure
in general practice
• reduce the time spent by patients in hospital
emergency departments when they can receive high
quality care in the community

Working together to deliver excellent and sustainable healthcare

 Local Models

Established: 2014 Wave 1 delivered through general practice

Four practice clusters in 2014 moving to central provision 2018
SLOUGH
Demographic needs, wider determinants, use of local services (DNAs)
Monday to Friday until 8pm, plus weekend (9am to 2pm) – 45 mins per 1,000

Established: 2015 Wave 2 delivered in collaboration with GP OOHs

Two community hospital sites – Maidenhead and Windsor
W&M Demand on current services, sustainability for general practice, patient insights
Monday to Friday until 9:30pm, plus Saturday 8:30am – 5pm and Sunday 9am –
1pm – 45 mins per 1,000
Established: 2015 Local Investment delivered by GP Federation
One delivery point based in local practice, with seasonal outreach
Bracknell Demand on current services, housing growth, patient insights
Monday to Friday until 8:30pm, plus Saturday 8am to 2 pm and Sunday am – 45
mins per 1,000

Working together to deliver excellent and sustainable healthcare

 Enablers
EMIS and Vision GPIT systems - mixed economy with multiple sites. Current IT
Solution: Black Pear and EMIS
SLOUGH Demand for doctor appointments higher in Slough – challenge to ensure the GP
capacity with the available levels of investment. Comprehensive on the day offer
from general practice a priority for Primary Care Networks

EMIS and Vision GPIT systems – two sites based in community hospitals.
Current IT solution: EMIS Clinical Services and Adastra
W&M Multidisciplinary team approach from day one: issue with the maintenance of
medical records between the IAGP service and general practices. Recruitment
remains challenging

All EMIS Practices and one site with outreach. Current IT solution: EMIS Clinical
Services
Bracknell Shifted workforce to a multidisciplinary team and learnt how to engage the
receptionist in practices to promote value of the new roles. Recruitment remains
challenging

Working together to deliver excellent and sustainable healthcare

 Engagement and Feedback
GP Patient Survey – overall experience has improved across East Berkshire since 2015, however
patient experience between practices is variable.
GPs & staff – indicated that the availability of additional appointment has made a positive
impact
Insights
FFT - All 3 providers score well averaging around 93% across and the general patient feedback is
positive

The Big Conversation (2018) –

65% of survey respondents are happy to see someone other than their GP, assurance on
skills from a trusted source was identified as a need to support this shirt
Feedback If reception staff were to offer an appointment with another healthcare professional then
reception staff would need to be trained on different roles and be able to communicate
how these roles can support patients
That patient notes need to be shared so that you don’t have to keep repeating your story.

IAGP East Berkshire Equality Impact Assessment repeated– early 2019

Equality
Vulnerable; Adult Groups i.e. homeless, sex workers and travelling communities

Working together to deliver excellent and sustainable healthcare

 Equality: Vulnerable Adults
• Difficulty in getting appointments • Embarrassment at having failed to follow
• Don’t see the same GP each time through previous treatment programmes
• Short appointments at which they and referrals
cannot cover all their concerns/history • Fear of knowing the true extent of the
• Lack of understanding of their complex conditions they might be suffering from
issues
• Embarrassment of attending public
waiting rooms

Working together to deliver excellent and sustainable healthcare

 Vulnerable Adults: Homeless

Pilot now in place through GP OOHs service linking with drug and alcohol services within the
SLOUGH town and voluntary services to support the homeless already established

John West House homeless centre in Maidenhead with referrals from Windsor homeless
support
Appointments made by an approved support person working with the homeless–
W&M community warden, police, drug and alcohol worker, homeless shelters
Project team meetings and feedback from patients drives project adjustments on month
by month basis – builds engagement and support for programme e.g. podiatry service

Outreach clinics started in December 2017 in conjunction with the Night Shelters which run 7
nights a week from Dec to March in Bracknell Churches.
Bracknell A GP, Nurse and Care Coordinator attend the weekly sessions for drop-in appointments
Patients see the same GP, and support team who coordinate the holistic care for the patient
and liaison with other agencies such as New hope Drug & Alcohol service, Housing, CMHT.

Working together to deliver excellent and sustainable healthcare

Working together to deliver excellent and sustainable healthcare
Working together to deliver excellent and sustainable healthcare

“Living on the streets you feel like
you don’t exist – your invisible- to be
welcomed into the Windsor Homeless
Service drop in on Friday’s you realise
you are someone and you have a
name you’re not invisible”
Quote from person at Windsor
Homeless Project
Working together to deliver excellent and sustainable healthcare
“The GP is helpful
and welcoming and
will be the same one
you see on each
occasion.” “The GP service is
more accessible as it
gives time to listen to
patients as
“I had a stroke when I was appointments are
in the Brett foundation longer”
drop in clinic, if I was in
the stairwell I would’ve
died” Quote from person
at the Brett Foundation
“If I didn’t have the service to
turn to I would’ve struggled. I
wouldn’t know where to
“You won’t be judged. If begin and how to piece all of
you are nervous, there the services together”
are people to help you
who understand
homelessness and other
concerns you might have”
 Key for sharing
with Access Review
• Technology needs to keep up with service changes – more to be done but
local solutions are not efficient
• One model doesn’t suit all populations – be flexible in commissioning and
delivery
• Location and facilities matter – distance to travel for patients and
environment for staff
• Communication and engagement – this cannot be done enough to support
staff in practice and patients to use services effectively
• General Practice access is a small factor in addressing the populations use
of urgent and emergency care services – it is a ‘trusted’ place
• Equalities – these needs to be addressed for those often most in need with
the greatest impact from more flexible services

Working together to deliver excellent and sustainable healthcare

 Lunch and networking

45 | National Review of Access to General Practice Services in England

 Table sessions
Please pick from three of the following sessions

There will be three sessions of 45 minutes.

• Patient and staff satisfaction

• Digital
• Reducing inequalities in access
• UEC
• Models of access
• Workforce and workload

46 | National Review of Access to General Practice Services in England

 Feedback from the table
sessions

47 | National Review of Access to General Practice Services in England

 Final Q&A session

Web: www.england.nhs.uk/accessreview
Email: england.accessreview@nhs.net

48 | National Review of Access to General Practice Services in England