Dr Siân Howell, GP in Southwark and Clinical Lead for Access in the Transforming Primary Care Team at Healthy London Partnership (HLP)
About five years ago, on a miserable and wet evening and after a long day at work, I was sitting with Southwark GP colleagues in a crumbly NHS meeting room, thinking how we could work together to deliver something new and different to improve access for patients.
Move forward five years later and Southwark now has two well-functioning Extended Access hubs, delivered by local GP federations and offering a great service to our patients and practices. This story has repeated across London where we, collectively, offer 8-8 care, 7 days a week to all patients across the capital through over 100 extended access hubs. That London was the first to achieve this 100% provision of Extended Primary Care Services (EPCS), is testament to the hard work of those developing and delivering these services.
As part of the HLP Transforming primary care – Access team we’ve been out and about looking at EPCS delivery across London and seen some fantastic ideas:
‘Ask About Extended Access’ receptionist badges
Post-operative wound care delivery
Winter pressures emergency department EPCS “pop-up” hub
Text messaging to reduce DNAs
We’ve also heard about EPCS challenges: indemnity rules, connecting clinical systems, funding stability and hope that we’ve helped by sharing learning and solutions across London.
Learning from my own area
In my practice in Southwark EPCS is an invaluable part of how we work. The whole team are involved -reception staff signposting musculoskeletal problems to The Physiotherapy First service, using EPCS resource to help manage dressings needs over weekends. The GPs in triaging same day need into EPCS slots. We keep up to date by sharing learning at our practice meetings, and visits and feedback from the ECPS team, using local data on service use, help us to feel part of the local team delivering this care.
The EPCS team use their data to flex the offer to best fit local demand. Quality improvement initiatives have helped refine the local EPCS services to make sure it changes to meet any changing local need e.g. providing a coil, implant and smear service – meeting the needs of the local population and supporting practices deliver care to their patients.
What we could do to improve:
There are lots of things we could still do better e.g.:
The HLP website has e-posters which we could use on our waiting room screens
We need to update our agreed script for reception (we should probably get some of the Lewisham ‘Ask about EPCS’ badges too!).
The success of EPCS across London has been a real catalyst for successful working between practices and I believe has helped to underpin successful at scale working This achievement shows how collaboration can give local populations extra services that would not be possible if practices were working alone.
The Transforming Primary care team have developed Maximising the use of extended access in London – The top 10 considerations and a GP extended access services: communications toolkit to support practices with a guide for promoting extended access to patients.
These documents will support ECPS services meet new, national utilisation targets (75% for services going live in 17/18, and 85% for services going live before 17/18) – aiming to make sure we make the most of this provision for our patients.
We’re continuing to work with STPs, CCGs, and EPCS providers to share learning and best practice across London, For example Southwark offers clinical triage to patients prior to them being offered a hub appointment supporting continuity and connections between the EPCS and its practices. In addition we will support systems as services move towards a more PCN delivered focus over the next two years.
We are focusing on the need to strengthen the connection of EPCS with other services – 111, Out of Hours, Urgent Care services, – making sure we make the most of the potential of systems and technology to help patients get seen by the ’right person, in the right place at the right time. Since November 2018, over 100% of London’s GP Extended Access hubs are connected and receive direct appointments from NHS 111/IUC services.
Despite the success of EPCS over London, we know this does not ‘solve’ our GP access problems. In London where we are seeing increasing patient dissatisfaction, and demand that is increasing faster than capacity. Those of us working in general practice know the value we bring to the system, and the HLP team is now working to support improvements for core hour’s access. Watch this space…..