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Pressure increases on CCGs to meet GP access targets

Patients 75+ must get same-day appointments, and 40% of people evening/weekend access

Louise Prime

Tuesday, 21 March 2017

The Government has stepped up the pressure on clinical commissioning groups (CCGs) to meet its targets for GP access in England, particularly for patients aged 75 and over who need same-day appointments. It also said that, in 2017-18, a total of 40% of the population must have access to enhanced GP services, including evening and weekend access. And it has insisted that care home residents at risk of hospital admission should first be seen by a GP or ambulance ‘see and treat’ model.

At the same time, it is requiring NHS England to ring-fence £3.582 billion within its allocation to CCGs to establish the Better Care Fund in 2017-18; and to ensure that the amount spent, from within this, on schemes identified in Better Care Fund plans as ‘social care’ in 2016-17 is maintained in line with inflation in every area.

In its NHS mandate for 2017-18, the Department of Health has set out its overall 2020 goals as:

  • Implementation of the measures to support general practice set out in the General Practice Forward View, including: improved access to primary care, ensuring 100% of the population has access to weekend/evening routine GP appointments; and 5,000 extra doctors in general practice, delivered jointly with Health Education England.
  • Measurable reduction in age-standardised emergency admission rates and inpatient bed-day rates; more significant reductions through the New Care Model programme covering at least 50% of the population.

And within these, what it regards as ‘2017-18 deliverables’:

  • Deliver 2017-18 core requirements for access to enhanced GP services, including evening and weekend access, to a total of 40% of the population.
  • Work with the Department to agree a programme of work to assess how best to meet the commitment that all over-75s will be able to access a same-day appointment with a GP if they need one.
  • Support NHS Digital and the Department of Health to provide practices with clinical data by named GP.
  • Achieve 20% coverage of the population by the New Care Model programme.
  • Assess progress of the vanguards and identify models consistent with the multispecialty community providers, integrated primary and acute care systems and enhanced health in care homes vanguard frameworks that can be replicated across the country.

The Department also said trusts must make A&E streaming mandatory throughout the system by ensuring that all care home residents at risk of admission to hospital are first seen by a GP or ambulance ‘see and treat’ model. It called on them to implement the agreed process to address hospital bed capacity issues, and implement changes to ambulance and 111 delivery models to reduce the rate of growth in demand for A&E services.

The Royal College of GPs has so far been unable to comment on the mandate; but it recently pointed out that “blaming GPs” for the NHS crisis would not help anyone. College chair Professor Helen Stokes-Lampard has said: “It is not the case that GP surgery routine opening hours are contributing to the pressures our colleagues in A&E departments are currently facing … It has never made sense to force GPs to offer services that there is little patient demand for. In many cases, practices have already had to actually stop offering extended opening hours because of a lack of patient demand for them … A patient will always be able to access urgent GP care when they need to, either through our routine service, or the GP out-of-hours service.”

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