Plans to bring in new out-of-hours doctors appointments at local hubs across Doncaster could ease pressure on A&E and allow patients to see doctors more quickly, say experts.
That is the view of panelists in the first part of our latest Donacster Free Press round table at the Devonshire House base of Primary Care Doncaster, the federation which represents the borough's 41 GP practices. The round table marked the 70th anniverary of the NHS by discussing health issues.
The new 'extended access' to GPs and other services starts in October and will be based at four hubs, on e in each of the north, south, east and west of the borough.
Our panel was Doncaser MP Rosie Winterton; Primary Care Doncaster chief executive Laura Sherburn; Doncaster Healthwatch chief executive Andrew Goodall; Doncaster Council public health consultant Dr Victor Jospeh; Doncaster Patient Participation Group members Barbara Bell and Geoffrey Johnson; Secondary care doctor member of Doncaster NHS Clinical Commissioning Group Dr Emyr Jones; Doncaster Royal Infirmary medical director Sewa Singh, and Rotherham Doncaster and South Humber Healthcare Trust care group, Jo McDonough.
What will be the effect of bringing in new out of hours GP and health appointments in Doncaster?
Laura Sherburn: The CCG has tendered a contract for extended access to primary care - 120 hours of extra primary care appointments. Primary Care Doncaster has won the contact so from October we will be delivering that extra capacity.
The model put forward on behalf of our member practices is multi-layered. We will be using some of the hours to deliver Saturday morning clinics in hubs around the borough.
They will be in neighbourhoods outside the centre, and there will be routine, pre-bookable appointments for patients that either can't get in during the week, who can come in and have their routine care delivered in hub centres. Part of the model is to provide some physio assessments, which will be delivered in the centre of Doncaster and that's intended to release pressure on GPs as well as give patients better or more direct access to physio assessments.
Part of the model is more same day access so the Saturday morning is pre-bookable. There are also some of those hours which are going to be delivered by our partner FCMS, Fylde Coast Medical Services, based here in the Same Day Health Centre in Devonshire House. They deliver GP out of hours services in Doncaster. They're going to put on extra same-day capacity for practices to book directly into, first thing in the morning, in the evenings, and at weekends.
The final element is to provide clinics for the most vulnerable people in society, at the conversation club for asylum seekers, and also at the homeless hostel at Wharf House, and at the Changing Lives centre. We're wanting to reach out to groups that don't routinely access primary care and have complex lives, that mean they don't routinely access their GP service. We're going to do drop-in clinics once a week at those three locations. That's a model with a lot of different elements because we wanted to make it as beneficial as possible within the capacity that we've been commissioned to provide.
For the FCMS appointments, we're gong to provide an hour, 7am-8am, of same day access that practices might be able to book into from the night before, Patient ring up and say I want an appointment first thing in the morning. They'll be able to access that.and then from 6.30pm to 8pm Monday to Friday that will be extra as well and then 8am until 8pm Saturday and Sunday.
Geoffrey Johnson: My practice in Rossington already does Saturday mornings
LS That's right, so this is over and above what practices are already providing and on a collective and collaborative scale, working together for each others' patients.
AG: I think the proof of the pudding will be what people's experience of it is and talking to people about the new service and finding out from them about what its been like. Healthwatch Donaster are keen to work with Primary Care Doncaster to talk to people about their experiences to find out how people's voices can influence the development of the services going forward.
Rosie Winterton: I'm sure one of the reasons for this is to reduce pressure on A&E which of course is very welcome. One of the great problems is people going to A&E because they don't think they can get in to see a doctor. People come to me and say 'the practice said go to A&E because the practice can't fit you in for a certain amount of time'. I think people will welcome it. I think it still leaves a problem in terms of the need for more GPs altogether but that is a slightly different issue.
Jo McDonough: We work together across the health and social care services in Doncaster and during winter we try and put together more detailed plans for supporting any spikes in demand. We found over Christmas that a lot of patients went to A&E because they hadn't remembered to get their repeat prescriptions before the bank holiday so sometimes some of those reasons for going to A&E are so routine that having that extra capacity should be really beneficial.to everyone trying to support that care.
Barbara Bell: It could be very helpful but we're rolling a plan at the moment about going to pharmacists for tummy aches, ear aches and that sort of thing, so that people do that instead of going to their GP. Now we've got something else we have to look at, sharing out of hours care. That is going to confuse people.. I think when it's rolled out it must be absolutely understandable.
Emyr Jones: The number of contacts between patients and health professional is much greater in primary care than secondary care, so to increase capacity in primary care makes sense particularly when people commonly complain they can't get an appointment at their surgery within hours that suit them. I think this is to try to help that, to extend the capacity of primary care to hours that will suit people better, particularly the working population. It extends capacity for the busiest part of the health service and also gives an alternative to going to the emergency department which is what people so often do. It is extending capacity, hopeful deflecting people from going to the emergency department, unless they really have a true emergency or accident. I think it's an appropriate investment.
LS: We don't want to market this as separate or different to anything other than what you already get from your GP. From a patient's perspective, access to this extra capacity is through your GP practice. It's not another phone call, its not another number, its not 111. You ring your GP and what a patient should see is more choice. and availability of appointments both pre-bookable and same day. We want to make a general practice the first port of call..
The same day access delivered at Devonshire House by FCMS, there will be one practitioner across those hours, so it is 44 hours of appointments per week in addition for the same day element. The Saturday morning hubs will be staffed by a multidisciplinary workforce, maybe four, five or six practitioners in those hubs, a mixture of GPs, nurses, and healthcare assistants.
Sewa Singh: We know about 20 per cent of the patients that attend our A&E could have been treated in general practice. That is data we collect on a daily basis. We get 250 to 300 patients a day attending A&E in Doncaster. If you work out 20 per cent from that, you're talking about roughly 50 patients who could be dealt with elsewhere, which certainly would ease the pressure on A&E and allow our staff to focus on patients that require their attention the most.
LS: Its important to stress it might not be with your own doctor or at your own surgery. The pre-bookable hubs on Saturday mornings are delivered in hubs across neighbourhoods. It will be a patients' choice whether they want to accept that appointment which may be with a practitioner at a different location within their neighbourhood or if they would prefer to wait. It's extra capacity withing the existing system.
Victor Joseph: From a public health perspective, if you look at the spectrum of people who need to access some of these services, we need to be mindful of some of the hard to reach groups and the wider population . There are challenges, particular for those who find it difficult to access some of these services, and we need to make them aware. We have spoken to groups as part of need assessment, particularly new arrivals and so forth and they are not familiar with the system. They try to ring their GPs and csn't get them, so they find it easier to go to the hospital, and that is what happens. That is something that we need to work on.
RW: People with mental health problems who might have a crisis. How does RDASH buy into this?
JM: We promote our crisis service with all GP practices and FCMS. I think it important as we roll this out, if it does mean there's a slight difference in where or when services are provided, and they are not fully aware of the crisis team, that we make sure those linkages are there.
AG: The provision of access for vulnerable groups is interesting. The work at the conversation, club, Wharf House and Changing Lives is welcome because it does offer access. Some people from groups like the homeless and refugees feel they don't have the same opportunity to access health services. As a result they don't access any health care or go straight to A&E.
RW: It reminds me of when I was minister in charge of A&E. We worked to get waiting times down which we did by using many of these methods, and encouraged pharmacies to play a role, along with social services, and charities, like those who work with people who may be discharged from hospital. One thing we talked about was having a falls strategy for older people who had falls
MC: Across social care DRI and RSaSH, we're now doing a lot of work around falls. As soon as a personal has a fall at home, if the ambulance attends, they contact a multiorganisational service . They say the patient has had a fall, they don't need to go to A&E, but they do need a bit of help to stay at home> We go out within an hour to be to prevent them having to to A&E. In the first year we've had over 400 people referred to that service - and 80 oper cent of them have been kept at home. Its been a great success across Doncaster.