Access all Areas

Dr Sian Stanley considers how to fulfil the demands for more access

 All roads lead to increased access. The word on the street was this would come via the PCN DES but to our absolute horror it has come through the GP contract.  

The contract changes have left me considering how a PCN could help practices weave in the capacity and access improvement plan, and protect practices.

I know some GPs have issues with PCNs. I don’t think PCNs can be a cure for everything, but I am considering ideas that may help practices fulfil the contract requirements without being drowned in work.

We have set up a minor illness hub that allows our additional roles reimbursement scheme (ARRS) team to work at the top of their licences while getting supervision and support from a GP consultant, who is a GP trainer financed with investment and impact fund (IIF) money. 

The hub operates in the afternoons at one of the town-centre practices.

The appointments are available for same-day use for face-to-face appointments and e-consultions. The practices have a share of appointments across the week according to their list size. A larger practice will have on average an additional 50 appointments per week. The intention is to expand and contract the service depending on demand, so in the summer the focus could be long-term conditions management, while winter will focus on acute respiratory conditions. During the Strep A outbreak last year, the minor illness hub was quickly transformed into a sore throat service. When we’ve had surges in Covid we have converted to a hot clinic. 

Have I spilt the atom with this idea? Well, no. 

Have I created infinite access to primary care? Well, no.

But we have explored a new way of working and increased the number of appointments we can offer. Then we can create a safe space for patients and clinicians, allowing senior clinicians to focus on more complex care. The patient feedback has been excellent and the ARRS team members enjoy working in the hub as they have dedicated supervision. Our ARRS team has varied backgrounds with different experience, and some members need a lot of supervision. Such supervision can be draining on a practice, so the PCN hub is a way of providing appointments without increasing the burden on practice teams. We have some registrars working there too who get a lot from the experience.

Don’t get me wrong. As a GP, I like a cheeky verruca presentation, but is it a good use of my time? For years, I have been wrestling with how I am best deployed. Sometimes while exploring the verruca other issues come to my attention. A minor presentation helps me get to know patients better and
I know this is appreciated. But GPs are on the endangered species list so I am sad to say my verruca days are gone.

Working at scale is a popular concept and there are merits to working in this way. We’ve found that if it is fair and we all play by the rules, we can make it work. I know this is like nails down a blackboard for those of you who feel that investment should only flow into the practice model but creating capacity must be a good thing for everyone.

Dr Sian Stanley is clinical director of Stort Valley and Villages PCN,  East of England CD Representative, NHS Confederation and a GP partner in Bishops Stortford, Hertfordshire