Case studies
GP access hubs in the North East of England
A few examples of work led by us: the challenge, what we did and what changed.
280,000
people in a mainly rural area, two main towns
2 hubs
GP-led, with hours matched to A&E/MIU demand
The challenge
A mainly rural area with approximately 280,000 population, mostly living in two towns, one on the coast, the other some way inland. The seaside town had significant pockets of deprivation. The Accident and Emergency department (A&E) as well as the Minor Injuries Unit (MIU) at the hospital serving this area reported that they were under pressure from the number of patients presenting with conditions that would more appropriately have been routinely managed through their registered GP surgery. Feedback from patients to their GP practices and to the local NHS indicated frustration at the difficulty of obtaining a timely GP practice appointment.
The local NHS were inclined to seek a solution which would alleviate the situation, while at the same time NHS England were indicating that they would support well-founded proposals to fund and improve GP access. We were invited to assist them to assemble the evidence, identify options and draft a preferred specification and business case.
What we did
Data analysis
No empirical study had been made to gauge the scale and incidence of inappropriate attendance at A&E and the MIU, consequently the first step was to conduct a systematic analysis of attendance data. To do this we worked with a GP to identify the codes used on hospital systems for presenting conditions which were appropriate for a GP practice setting. This gave us parameters for drawing down relevant data and assessing this against day of the week, in time bands, by registered GP practice, age band, etc.
The picture this drew was of mainly working age patients, with no particular geographical concentration attending A&E/MIU in an asymmetrical pattern, with peaks during midweek evenings, Saturday all day, and Sunday mornings.
To coincide with this the local NHS patient liaison team provided us with a breakdown of letters and emails received which related to GP access and the patients attending A&E. This gave some qualitative support to the evidence from the hospital data.
Engagement
There were three strands to our engagement strategy:
- With the Local Medical Committee (LMC) and GP federation as representatives of the GPs in the area
- With representatives of patient participation groups (PPG) and the local Healthwatch
- Working with the NHS/local authority communications team to canvass opinion via structured interviews at key workplaces, railway stations/trains, and some other public locations.
Our questions to the LMC were focussed on recognition of the issue and to encourage suggestions for a sustainable solution. The output from our PPG, Healthwatch and public survey work was that members of the working population commonly found it difficult to obtain a GP appointment or attend a medical centre during working hours Monday to Friday.
Assembling the proposal
Data analysis and the engagement exercise pointed to a set of options, of which the best fit in sustainability and cost was a two hub model. An assessment of travel time from the main nodes of population indicated the optimum location for the hubs, and this, with the assistance of the GP federation, pinpointed primary care estate which were the best fit for a hub. The hubs would be GP led and with operating hours and staffing to match the demand indicated by the earlier analysis of A&E/MIU usage.
Output
A business case and accompanying service specification were prepared, a core part of which was the estimated opportunity cost saving to A&E/MIU through patients being seen through a more appropriate and less costly primary care hub. This was submitted to NHS England, approval was received, and preparations for mobilisation began. On learning of this initiative, four practices from an adjoining NHS area requested that they be included in the scheme, and this was agreed to. Additional proportionate funding was made available.
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