How do we offer Improved Access with limited staff?

Problem

The demand for Primary care services are increasing, more people are working, the increase in demand is acutely seen in working-age populations.

Approach

The Improved Access service is designed to provide GP Practices with an additional option when they are unable to offer a suitable appointment during their own opening times. It is not an alternative to the usual GP Practice. We use local staff to make the most of their knowledge. Currently employing 23 GPs, 17 nurses and 9 receptionists. 4 practices cover the Bath & NE Somerset (BaNES) geographical area as hosts; in Bath city, Paulton and Keynsham. As most practices use SystmOne this is our Electronic Medical Record System (EMRS) of choice. This allows booking directly into the service by the practice, increasing confidence by patients, plus clinical notes to be both accessed/updated in real time. When booking an appointment, the Practice asks for consent to share the individual’s medical records with the service. Appointments are available Monday-Friday 18:00-21:00, Saturday/Sunday 08:00-12:00, with appointments available up to 4 weeks in advance. We monitor the presenting problems by splitting into general/mental health/dermatology/gynaecology/acute/systemic illness/MSK. The clinicians can refer for further investigations and to other services. The EMRS ‘task’ method is used to inform home practices of attendance/outcomes.

Findings

Clinics have recently run at 91% of booking capacity, GP appointments 90%, nurse 70%. The wait for an appointment is most commonly 2 days, 61% of patients seen within 3 days of request. We have monitored which practices refer, the number of patents, total, and from each practice. All practices refer. The numbers of patients aged 0-16y and >65y has always been low compared to 17-65y. The number using the service has been steady since February 2019 (means 0-16y 77/month, 17-65y 717/month, >65y 137/month). More females (+/-30%) use the service than males, mirroring primary care nationally, the pattern of use paralleling each other. The main presenting problems are (excluding general problems) Dermatology and MSK – Mar-Sept 2019 550 and 509 patients, 26% receive prescriptions, 5% further investigations, 3% secondary care referrals. Patient satisfaction survey results continue to show 100% positive rates, with a mean return rate of 31%.

Consequences

Those practices that historically did not use SytmOne at the beginning of the project have a reduced uptake but since they have changed access use has increased. The host practices use the service more –the surroundings for patients may play a part as the staff vary. NHS England and the CCG have suggested considering providing additional sessions to better meet the contractual obligation of 95hours per week – current mean 81hrs. To increase staffing, we may consider using ANPs to compliment to GPs to assist with prescribing. The presenting problem use shows we need to employ staff with Dermatology and MSK skills.