In some areas, practices have joined up to use GP appointment pooling schemes or Hub systems, which could offset the need for very short term locum cover and increase or improve access.
One such scheme is in existence Richmond, South West London, and is funded by the Prime Minister’s Challenge Fund. The local GP Federation (of all 28 practices in the patch) operates 4 Hubs, each based in an existing general practice surgery and each one covering a locality of approximately 50,000 patients.
"The practice manager – who couldn’t find a short notice locum - called the Hub, and all patients who wanted were smoothly transferred in to appointments the same day."
Each Hub can access any patient in Richmond’s notes – with their permission. In the first 6 months of operation approximately 40,000K patients were seen in the Hubs, with only one refusing to allow the Hub GP to access to the GP record.
There is true read and write interoperability between different GP systems - so Vision and Emis practices both enjoy instant updates and fully-coded entries etc. This means that no extra paperwork is generated as a result of their patients being seen at the Hubs. It also meant no practice had to endure the disruption of changing clinical systems to enjoy interoperability.
The Hubs add another 5-8% appointments in to the system – taking some strain off local general practice. Practices triage calls, decide who can and should be seen at the Hub, and book the appointments. This means that (almost) every patient seen at a Hub is a patient who had requested an appointment in general practice; this stops the extra appointment availability from driving further demand. It is made clear that the Hub is an extension of the practice, not an alternative.
It appears popular with patients (in a formal evaluation over 80% of patients rated the Hub as ‘excellent’), local GPs, and also the GPs operating the service.
Hub GPs see 14 patients over 4 hours at 15 minute intervals. Hub GPs are well-looked after in the host practice, and meet regularly to discuss operational and educational issues. Many Hub GPs are local GPs performing extra sessions; but many are locum or sessional GPs who enjoy the flexibility of Hub sessions.
Practices meet regularly as localities to discuss the functioning of the Hubs, equity of access to appointments, and to develop the service. The extra resilience offered is very popular. On the very first day the first Hub opened, a single-handed GP called in sick from the South of France with a burst appendicitis. The practice manager – who couldn’t find a short notice locum - called the Hub, and all patients who wanted were smoothly transferred in to appointments the same day. Other practices have used the Hub to smooth over periods of staff sickness or leave.
Mondays-Saturdays are mostly full, Sundays mornings half full but afternoons and evenings have been mostly unused, with notable exceptions. 111 are starting to refer in at weekends (rather than to A&E), with 80 referrals in the first month. We are planning to extend access further to support a local Pharmacy First project (to encourage patients to use pharmacy for minor health care issues), and are discussing integration with out of hours services.
Early figures suggest a positive impact on A&E and urgent care numbers, despite minimal patient awareness.
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