Plans to effectively mandate same-day access hubs in one area will go ahead but with a ‘phased approach’, Pulse has learnt.
In response to ‘immense’ concern raised by local GP leaders, North West London (NWL) ICB has apologised for the ‘confusion, anxiety, concern and anger’ caused by the way its proposals have been ‘perceived’.
Pulse revealed earlier this month that NWL ICB, the third-largest system in England, is effectively mandating the use of ‘same-day access hubs’, leaving GP practices with only ‘complex’ care.
The new model of care, defined as an ‘access’ requirement, is being introduced as part of the ICB’s enhanced services ‘single offer’ worth £75.4m, with practices obliged to sign up to all services to access the funding.
Londonwide LMCs has previously said that the fact this is being pushed through a single offer is effectively ‘mandating’ the new model of care.
Yesterday, the ICB acknowledged the concerns in a letter to GP leaders seen by Pulse, but emphasised that the single offer had been through ‘comprehensive sign off’ which required ‘a lot of scrutiny and agreement’.
However, the commissioners seemed to have softened their approach to implementation, telling GP practices that there is ‘no expectation that there will be a fundamental change in the same day delivery’ on 1 April this year.
‘We cannot now unpick the access aspects from the rest of the programme without calling into question the whole piece of work,’ the ICB primary care team confirmed.
But PCNs, who will organise the same-day access hubs, will be able to work towards delivering aspects of the new model ‘over the course of 2024/25 and the subsequent year’ as part of a ‘phased approach’.
The letter said: ‘The phasing that is appropriate to each area will vary and consider what is already in
place and any constraining factors that each area has, such as estates.’
During the transition phase, GPs will be given flexibility over the ‘quantum of same day demand being triaged at scale’.
The staffing mix of the hubs, which will include both GPs and ARRS staff, will be at the ‘discretion and determination’ of the PCN.
Responding to concerns about continuity of care, the ICB’s primary care leaders said: ‘The purpose of this programme is to help liberate GP practices from managing low acuity reactive and episodic same day consultations and so enable them to see more of the patient cohort where continuity really adds value.’
Londonwide LMCs had also raised concerns about the potential for the programme to widen health inequalities, but the ICB responded that the ‘programme is still in its infancy’ and it will share equality impact assessments once they have been undertaken.
The letter also referenced the Fuller stocktake, an influential review of primary care which put forward the idea of wider neighbourhood teams managing urgent same-day appointments rather than individual GP practices.
Pulse has recently reported on other areas which are moving towards the same-day hub model, including Buckinghamshire, Oxfordshire and Berkshire West (BOB) ICB, where the hubs are set to become standard, and Cornwall, where retired GPs will help to provide extra on-the-day GP appointments.
So – “we are sorry, but we are doing it anyway”.
I am increasingly convinced that these idiotic folk wrecking primary care will eventually be held accountable.
Is it being made contractually mandatory to abandon the GP’s own patients to attend the same-day hub sessions?
Such a significant contractual change could well be contrary to equity of access to that GPs own patients, as well as a breach of contract negotiations. It may also invalidate secondary contracts, like insurances and staff contracts.
I hope they’re held accountable but seriously doubt so; they just move on.
Fuller has no legitimacy except on her own so say. It’s DHSC/NHSE pretending it’s a new must-do and a brainwave, when in fact it was part of STPs’ reorganisation plans before 2015. Cynical and specious.
Do we need another (very) structural reorganisation; will it improve care; is it actually predicated on ARRS no longer being a GP service; is it currently safe and where is Fuller’s evidence, evaluation and impact assessment; how ignorant is the premise that acute/urgent/chronic cases can be neatly triaged like coin-sorting; who is supervising the failures of care, unmet need, enormous crossover, massive holes in noctor knowledge etc?
The Fuller Stocktake has no legitimacy. Worryingly, DHSC/NHSE have developed the power – via Covid and ICBs – which they could not have so readily achieved, via CCGs: to change the manner in which clinical care is practised. These are dark days for Medicine and for patients. This is not progress.
Don’t know about Fuller’s stocktake, but Fuller’s earth is pretty good…… for cat litter.
#FedupwithAnotherCynicalNHSEImprovementreport
Presumably “low acuity” problems will be referred to Optician or Opthalmology?
Fuller’s London Pride is an under-rated beer – ironically it’s a bitter
Potentially a useful resource if this scheme goes ahead
Continuity really matters in same day acute care too. Think of the young kids who need seen more than once in the same illness. The importance of continuity within that illness and in the support it provides to the parents should not be dismissed.
new money for this and the pharmacy first PECS CUES WIC etc etc will almost certainly mean at best flat cash for general practice when inflation returns to 2%
Remains to be seen what Labour does with ARRS PCNS and Fuller
My guess is that they will baulk at ever rising costs in 2′ care swollen admin staffing and flat productivity and try to shift stuff into the community