An LMC has criticised plans by its local ICB to spend £315,000 a year on a new hospital-based primary care service instead of investing in local GP practices.
Leicester, Leicestershire and Rutland (LLR) ICB is consulting on new proposals to implement a same-day access service – led by nurses – in a bid to ‘free up’ GPs’ time.
It wants to replace the current minor injury and urgent care services with a new ‘primarily appointment based’ service, pre-bookable through GP surgeries and NHS 111.
The ICB argued that the service, which would be open seven days a week in Rutland Memorial Hospital, would ‘reduce demand on primary care appointments’, by ensuring that patients ‘receive a response to their health issue within 24 hours’.
But the local LMC told Pulse that this would be a conscious decision from the ICB ‘not to invest into general practice’.
The new service would be provided by nurses, advanced nurse practitioners and ‘other clinicians’ who have ‘access to and guidance from a GP’.
The cost of the service would be £315,000 per year and would be funded ‘through the existing NHS budget’, according to a business case prepared by the ICB.
The document said: ‘With the implementation of a same day access service, this will free up time and capacity to allow for the GP practices to focus on the long-term management of patients and prevention, therefore supporting patients to remain well, better controlled and less likely to become ill in the first place.’
The ICB said that the number of appointments offered in Rutland each year via the current minor injuries unit and the urgent care centre is approximately 6,785 and under the new proposals the number of available appointments would increase to 7,644, as a ‘centralised’ service would be more ‘efficient to run and would reduce duplication’.
But LLR LMC chief executive Dr Grant Ingrams said that local GP practices ‘need more capacity’ and that these proposals are not going to help with that.
The ICB business case points out that improvement in Rutland Memorial Hospital estate that will be funded using ring fenced Community Infrastructure Levy (CIL), but Dr Ingrams argued this could have been spent on GP practices instead.
He told Pulse: ‘We have got an increasing population and they’re choosing not to invest in GP practices by providing care through these types of centres.
‘But this means you’re not providing continuity of care, which gives you the best long term care and the most cost effective care.
‘This isn’t about investing in what the population needs, which is better primary care and general practice. This is deciding not to invest in general practice again.’
The ICB’s Rutland clinical place lead Dr James Burden, who is a GP, said: ‘As part of the new proposals we will be looking to provide services from one place, with a consistent way of booking appointments and easy to remember opening times.
‘As well as improving the quality of care, it would also mean that patients will be able to have a better experience in modernised facilities.
‘The new proposals would also mean that fewer people would need to travel outside of Rutland to receive care, as this would instead be more easily accessible in Rutland.
‘We hope the consolidation of these services will also mean that treatment can be accessed faster locally and will reduce the number of people attending the emergency department or needing hospital care.’
The public consultation on the proposals opened today and will end on 16 March.
Other ICBs around the country have also drawn up plans to improve same day access which have caused controversy.
Last year, Pulse revealed that primary care hubs designed to ‘ease on-the-day demand’ on GP practices in Cornwall are set to be expanded, as part of plans to ‘transform’ general practice.
In North West London, the ICB asked GP practices to come up with their own plans to improve access in order to access funding that had been tied to now-scrapped same-day hubs.
The notion that same days hubs reduce the pressure on Gp practices is utter shite. The Gp’s still see as many patients as they did before – just different stuff – such is the unquenchable demand. Additionally the GP inevitably has to pick up all the admin generated by the hub – as well as their own admin. Hubs worsen the pressure on Gp’s.
Their own figures seem to show an increase in available appointments of about 900 per annum. That is less than 3 a day and expensive for a budget of over £300,000.
Not a very effective use of the money.
The new service would be provided by nurses, advanced nurse practitioners and ‘other clinicians’ who have ‘access to and guidance from a GP’.
Essentially a non doctor based service running to provide care with minimal GP input. Just further dilution of primary care.
“GPs criticise….” has achieved nothing with successive faceless unaccountable organisations who don’t consult/listen/utilise evidence. When will we learn???
I fear we are now at the tipping point where we can no longer absorb the mismanagement of all other parts of the system. I am truly frightened about what may happen next for patient care and our GP workforce. So sad.
Practically if given this money to PCN, unless ring faced to recruit more nurse or GP, “IT WOULD HAVE GONE TO LINE THE POCKETS OF DIRECTORS OF PCN”, waiting room of surgery would have remained empty with no increase in number of appointments. whole system of PCN and ICB is rotten.
I wonder whom the money is really go to?
£315000 would pay for about 3 salaried GPs at 8 sessions each for 1 year.
1 GP would see 24 patients daily x 4 days per week x 44 weeks = 4224 people per year
3 GPs would see over 12500.
Why are they quoting an increase in appointments of under 1000?
Something smells fishy.
The wrong individuals continue to hop between lucrative ICB and PCN CD positions motivated purely by huge £180,000 approx salaries in ICBs in my opinion along with overpaid PCN CD roles for simple admin work on remote coffee fuelled meetings covering up disaster after disaster. How have we allowed this relatively small self selected , unrepresentative, ineffective failing group to direct in my personal view, this continual path to failure with immeasurable degrees of evidence across the board of the ongoing decline in patient care , career destruction of all groups of GPs or other NHS staff and an ongoing decline in the NHS. The NHS will not recover until in my view , this incompetent status ,power hungry and money chasing group of unfit leaders across the country are removed and replaced by those whose interests are not simply personal gain or leadership titles on a background of ill considered change for the sake of change to disguise their mediocrity and ineptitude.
The maths is important, and revealing. £315K to deliver 7600 appointments = £41.44 per ANP consultation.
This equates to an hourly cost of £165.79 (if 15 minute appointments are offered) or £248.68 (10 minute appointments).
I bet the figure used for hourly GP cost in local LCS negotiations with the LMC is very significantly lower.
So, this nurse-led service would seem to be extraordinarily more expensive than a GP-led service, suggesting that the reasons for making it nurse-led are political and not clinical; and also that it offers poor value for money compared to investing it directly in general practice.