The Extended Access Service aims to make it easier for people living in Sheffield to get an appointment with a GP or another health professional within a primary care setting. The service is delivered by Primary Care Sheffield and is based on the learning from a pilot programme that ran in Sheffield in 2015/16.
Enhancing Primary Care programme – the pilot
In October 2013, the Prime Minister announced a new £50 million Prime Minister’s Challenge Fund (PMCF) to help improve access to general practice and stimulate innovative ways of providing primary care. Further funding of £100m was made available for 2015/16. Led by Primary Care Sheffield, Sheffield bid for and was awarded £9.3m making ours the largest of the 37 bids approved.
The bid involved all of Sheffield’s GP practices representing over 500,000 registered patients, working in partnership with the city’s health and social care organisations: NHS Sheffield CCG, Sheffield Teaching Hospitals, Sheffield Health and Social Care Trust, and Sheffield City Council, as well as voluntary sector organisations. The funding was used to pilot a range of 16 innovative schemes including providing urgent appointments with a GP on evenings and weekends, enabling patients to have online consultations from the comfort of their own home, providing a pharmacist’s time within GP practices and providing more support to help people use the healthcare system more wisely. The pilot also extended other services aimed at treating people outside of hospital settings and closer to home.
The programme lasted for 1 year and has now come to an end, though the learning and some of the schemes put in place have now been commissioned.
Evaluating the programme
An independent evaluation of the Enhancing Primary Care programme was conducted by Sheffield Hallam University. This aimed to provide an unbiased review of how the 16 pilot schemes within the Programme had delivered on the overall aim of improving access to primary care. It also aimed to identify where there was the potential to further develop and embed those services where there had been a positive impact.
The evaluation told us that the schemes:
- Improved access to primary care in the city, by extending the hours of operation and increasing the number of appointments available. 24,448 appointments were provided October 2015 to November 2016 with 90% approval ratings from patients and although some appointments were considered not to have been for urgent needs, less than 1% were considered inappropriate by the GPs working in the Satellite Units.
- Demonstrated a significant level of engagement and participation by 87 practices working together and closer to other professionals from across the health and social care system.
- Released 3171 hours of GP time and provided specialist expertise in medicines and prescribing, as well as enabling closer working between GPs and Pharmacists.
- Created an additional 30,068 in hours’ appointments for acute same day needs.
- Provided a primary care solution for patients who would otherwise have attended A&E.
- Provided health literacy for a marginalised population who had previously shown an overreliance on A&E for health care.
- Supported practices in providing care to house bound patients.
The full Enhanced Primary Care programme evaluation report is available here.
The Evaluation Summary is available here.
Areas in development
We acknowledge that though the schemes piloted evaluated predominantly positively, there were some learning points that we have already built into planning for providing extended access in the longer term.
We have also learned from aggregated data showing rates of access to the Satellite Units, Walk in Centre and A&E at both a practice and neighbourhood level. This data has highlighted some interesting differences in the use of all these services across the city. For example, there are patches of the North of the city where patients are low users of the satellite units but high users of A&E whereas this is reversed in other areas. Though we need to explore why this is the case in more detail, these differences in the utilisation of the Satellite Units are something we are already working to address.
We want to ensure that all practices and ultimately all patients have fair access to appointments. To do this we need to engage with those practices which the data suggests are referring a low number of patients. We want to understand why this is the case and whether there are any potential barriers preventing their patients from using the service more fully, whether these are barriers that we can put measures in place to address quickly and easily or more ingrained issues that may be a result of place-based, cultural differences or the alternatives for managing urgent care demand already in place within the practices in the area, such as drop-in clinics.
Equally, we need to understand why some practices have a much higher rate of referral. We have already introduced some booking restrictions for those practices who are high referrers to try to ensure fairer access. However, we also need to understand whether there are underlying reasons why we are seeing this disparity and your feedback and insight into this is incredibly valuable.
Developing the service
As well as increasing the fairness of access to the satellite unit GP and nurse appointments for practices booking into them, we are also working to enhance the provision to offer even more choice for patients in how they access primary care. This includes the addition of mental health workers and expanding the role of nurses to provide a wider range of services out of hours, such as smear tests.
From July, we have also introduced Extended Scope Physiotherapists into the satellite units. These Physiotherapists provide a first contact service for the assessment and triage of possible MSK pain or related conditions (which may include Rheumatology, Cardiovascular or any other specialties that present with pain).
We are also exploring the opportunity to provide a Thursday afternoon service through the satellite units for patients whose registered practice would normally be closed, and Diabetic reviews.