Enhancing GP Access in Southend: Strategic Changes and Outcomes

1. Access to GPs Changes in Primary Care – Improving Services Ian Stidston

2. National Targets • Access to a GP within 48 hours • Access to a health care professional within 24 hours

3. GP Infrastructure • 41 Practices • 33 Local Contracts • 5 National Contracts • 3 Primary Care Trust run • 63% of practices are classified a `Single Handed’ practices • 2063 is the current average list size across Southend

4. Before the New GP Contract • In 2002-3 there were 3,699 compulsory allocations across Southend • Patients were routinely reporting having to wait up to 10 days before an appointment with a GP • Southend was one of the highest under doctored areas in England

5. October 2002 – Introduction of a Local Contract 33 Personal Medical Services (PMS) Additional Investment which allowed for: • Increased number of GPs • Increased number of Nurses • Recruitment of European GPs

6. Advanced Access If you do what you have always done, you will get what you always get.

7. Advanced Access 2003 – Southend PCT engaged practices on`Advanced Access Collaborative’ • Recording and analysing demand • Make changes to appointment systems, mising book on day and advanced bookings • Implement new ways of working (telephone conversation, nurse triage, text messaging) However, not all practices applied the methodology fully

8. April 2004 – A New GP Contract • Establishment of Open or Closed Lists • A Directed Enhanced Service to reward practices for meeting access targets • Establishment of a set of measures that reward quality in primary care (QMAS)

9. Current Monitoring of Access • Monthly telephone surveys (Primary Care Access Survey) • Quality visits • Contacts through PALS • Monthly monitoring returns submitted to the PCT

10. Current Position • Zero compulsory allocations • Oct –Dec 2005 PALS helped arrange 20 GP appointments (reduction of 42% from first quarter) • Feb 2006 – Practice evidenced that they are able to offer patients an appointment within government targets • PCT investigates direct evidence of patients not being able to access a GP within access targets

11. Current Position • Circumstances will arise where pressures occur in practice and the PCT will assist practices to resolve situations as far as practical

12. The Future • A new Directed Enhanced Survey for Access (2006/7) is being introduced • Part one – Practice plan demonstrating how practice will achieve access and its agreement to participate in the Primary Care Access Survey (revised)One Third of Payment • Part two – Will be paid based on the results of a national patient experience survey Two Thirds of Payment

13. The Future • Breakdown of Second Payment • Two working days 30% • Advanced Booking 30% • Telephone Access 30% • Preferred GP 10%

14. The Future PCT needs to continue to work to support and incentive existing practices patient access PCT needs to increase overall capacity to ensure increased access to primary care