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EA (extended access) is the offer, to registered patients of a practice, of pre-bookable appointments outside core contractual hours – either in the early mornings, evenings or at weekends. NHS England’s planning guidance suggests clinical commissioning groups will receive at least £6 per head (a cost per appointment hour of £230).
Many areas are offering this through central hubs, which are like a shared overflow capacity where GPs can see patients registered with local practices while accessing their full medical record. Services are sometimes slightly more restricted than their own practice eg no routine referrals (only 2ww), repeat prescriptions or fit notes.
The benefits of hub work
The patient is booked into the hub by the home practices (patients cannot book into them directly), by 111 or by OOH organisations (after initial triage). Patients really value the same-day access, and for GPs, hub work can be a refreshing change from the complex multi-morbidity work of a salaried or partnership role. Fifteen minute appointments with no visits, administration or scripts provides a degree of control and predictability which many strive for, and the shift nature means it can be used to top up regular work – eg in term time – and provide added flexibility.
Hub work and indemnity
Working out what level of indemnity you need can be a nightmare. While the indemnity category of ‘scheduled care’ (booked appointments between 8am and 8pm by registered patients with access to the full record) seems easy enough to confirm, there are various caveats.
For example, MDOs differ regarding whether the route of booking hub appointments (via 111 or OOH services) makes the work ‘unscheduled care’, which is more costly. Some GPs have been stung by retrospective indemnity costs due to this issue. Weekend hub working is treated differently to weekday hub working by one of the three MDOs but not the other two.
‘The case mix seen is in line with normal routine in-house GP care’ is another MDO scheduled care descriptor statement, which is hard for the prospective hub GP to ascertain. Hub appointments are often booked at short notice and therefore likely to have a higher ratio of urgent to less urgent cases.
Hub work and rates
Hubs may entice scarce locums away from practices and so there is considerable political pressure to keep payment rates in hubs at or below standard market rates for practice locums.
IT systems, risk and safety
Access to medical records can be hampered by IT issues or a failed consent process, leaving the hub doctor with the unenviable choice between a) declining to see the patient due to not being indemnified (risking a complaint) and b) agreeing to see them (in breach of GMC guidance). Where localities run two IT clinical systems the hub needs to be able to handle both.
In a new model of working, often delivered by shift workers both from a clinical and administrative side where there is no senior support on-site, clarity of systems is vital. It is unsurprising therefore, that at least one service has run into problems with CQC over lack of systems to act on significant events. “Staff felt hesitant to give feedback and discuss any concerns or issues with colleagues and management as these were not acted upon and there was a culture which discouraged staff from highlighting concerns.
If you are considering Hub work there are a few key questions you will want to ask:
Paula Wright is the north east representative for sessional GPs
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Can you give me some contact details as i am interested in working for the hub. Thanks
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