There is no thornier healthcare topic at the moment than Enhanced Access – essentially, the requirement on Primary Care Networks (PCNs) to provide appointments between 6.30pm-8pm on weekday evenings, and 9am-5pm on Saturdays.
The new hours are due to start on October 1st, 2022, and the PCNs are busy working up their plans on how this will work, which will be submitted to commissioners by July 31st.
There are openings here for the Pharma, Med Tech and Devices industry and the NHS, with some of your projects and support, converting to be services and appointments in these hours – I already have a small number working with my NHS client base.
We are also likely to find collaboration between more than one network, networks could also potentially subcontract the hours to a GP Federation or another local provider.
But the key thing to remember is there are opportunities to make this task – which is not easy and is unpopular among some of the very people who need to make it happen – slightly less difficult to accomplish.
What do the new Enhanced Access rules mean for PCNs?
It’s crucial that all practices in the network play an active role in deciding and agreeing how they’re going to deliver this. It builds on the extended hours access that the Primary Care Networks have been delivering, but it’s a significant change.
Practices would, in the main, previously deliver their own extended hours for their own patients. It was 30 minutes per week, per 1,000 patients. So, a network of 50,000 patients would have 25 hours to do – that would work out at five hours a week each for five practices (assuming they were all 10,000 patient populations).
The difference now is it doubles to one hour a week. And the key change is that whichever site is open must be available to all patients within the Primary Care Network. So, we can no longer have practices open just to serve their own patients.
There’s no restriction dictating that they have to offer a certain percentage of acute on the day appointments and a certain percentage of planned appointments. But I think it’s safe to say that there is an expectation there will be a mix. The commissioners have got to sign off on the plan and I would think most of them will want a mix of planned care and acute on the day appointments for when the practices overflow.
Not a lot of money to go round
So what exactly is it that the Primary Care Networks are expected to offer? As we’ve said, they must have bookable appointments between 6.30pm-8pm on weekday evenings, and 9am-5pm on Saturdays, which can be a mix of face to face and virtual (online, telephone etc). There is no exception to that.
So yes, they can still offer 7am-8am on weekdays or Sunday appointments but that would have to be in addition to the obligatory times above. As an example, I’m aware of one area that offers a Long Acting Reversible Contraceptive (LARC) clinic between 12pm and 2pm as an extra service and they may be allowed to deduct those hours off the new weekday and Saturday requirements, but would still have to deliver 6.30 to 8.30 Monday to Friday and 9 to 5 Saturday. That is set in stone.
So it then becomes a question of how practices handle it. And the place to start is the budget. Here’s an example:
- 52,000 primary care network population
- £7.44 per head of population to spend (from Oct 1)
- 52,000 x £7.44 = £386,880
- £386,880 ÷ 52 (weeks in the year) = £7,440 per week
- £7,440 ÷ 52 (hours in a week) = £143.07 per hour
So it’s not a massive amount of money. And the one thing that sum rules out straight away is every practice being open all those extra hours. It’s simply not possible for the cash available. But you wouldn’t want to do that anyway.
Subcontracting may be best way forward
A lot of the networks I come across are looking at models where we open different practices for the extra hours on a Monday to Friday and we have a hub on a Saturday. I’m not convinced that idea will get signed off as it could be confusing for the patient to have one practice open on a Monday, a different one on a Tuesday, a different one on a Wednesday and so on.
Many of the ones I work with are looking at a hub that just covers Monday to Friday and a Saturday.
But for those that really don’t want to deliver, they’re looking at subcontracting some or all of the hours to another provider, most often the GP federation and I think that’s a helpful idea. It should make it easier for networks to deliver because it brings scale, it will bring a bigger pool of staff and it’s a model already running across the country – the commissioners have already got people delivering the services, Monday to Friday, and then over the weekend.
I also think it’s a clever play for the network to renew the contract of the existing provider between October and March next year to buy themselves some additional thinking time to work out what to do and what they really don’t want to do.
Most networks will be able to set up and run a service by October 1. But it’s not October 1 2022 I worry about – it’s October 1 2023, 2024 and 2025. Will the networks have enough people to deliver these hours on a consistent, long term basis?
Keep your current links strong
Therefore, my encouragement to networks is think long term, not short term. When you find those existing arrangements that have been there for five years plus, with a load of in-built system links, you don’t really want to destroy that.
If you pull that apart and then in six months find that you can’t deliver the hours and you need to go back to the federation, you may find it is no longer willing or able to supply what you need.
If as a network you do decide to deliver, I would start to look at what your practices are already struggling with. Are there backlogs and difficulties in the Quality and Outcomes Framework or the Investment and Impact Fund?
Practices might be struggling with staff turnover – they may have had a diabetic nurse specialist for example who saw lots of patients but left or retired and wasn’t replaced and now there’s a backlog. So putting that kind of planned service into some of the networks Enhanced Access might work well.
I would be surveying the staff team in the primary care network and finding out whether or not we’ve got enough people willing to consistently offer evenings and weekends to make the new rules deliverable. We’ve also got the Additional Roles Reimbursement Scheme and I’d be encouraging anyone recruiting through that to put in a requirement for some weekend and evening work.
Don’t try to cut corners – they’ll spot it a mile off
So the message from me is to make sure you really understand the specification and exactly what’s required. If you try to get away with doing the minimum, the commissioners will see straight through that, and your plan is unlikely to be signed off.
And think about scaling. I don’t think this was ever intended to sit at network level. I think it was much more about scale and the bigger provider companies continuing to be subcontracted to deliver what’s required here.
That might well be a good route for many to buy some time to think about the real ask in this quite tricky specification. General Practice may not welcome these changes but they’re ultimately contractual – and so General Practice will have to step up and deliver, which of course it always does.
From the Pharma perspective, some of the service ideas and projects that are currently happening could fit really well into these new hours. Conversations with the customer base about how these projects and tools could help the practices deliver are absolutely essential.
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