Improving primary care access out of hours

Improving access out of hours: evaluation of extended-hours primary care access hubs | The Nuffield Trust 

This report explores whether schemes aiming to increase the availability of primary care access out of hours improved the overall quality of services and patient experience in north London. Barking and Dagenham, Havering and Redbridge CCGs commissioned this report to evaluate the impact of access programmes in their areas.

Key findings

  • Most of the patients interviewed told the researchers that they had chosen to attend the hubs because they found it difficult to attend in-hours primary care services. Others said that they had wanted a speedy clinical assessment for themselves or their children.
  • Patients particularly liked the appointment-based system at the hubs and this was what they highlighted when distinguishing between the hubs and other services such as walk-in centres and A&E departments.
  • Since the hubs opened, there has been an increase in the use of A&E services across the boroughs. However, during the research the size of this increase appeared to be associated with hub attendance in that it was significantly lower in areas where hub attendance was highest by approximately 4.5%. This suggests that the presence of the hubs may have been diverting some people who would otherwise choose to attend A&E, or who may have been sent to A&E by NHS 111, away from this service.
  • However, from a commissioning perspective, such reductions in A&E attendance would not be enough to offset the local cost of providing the hub service.
  • During the study, a call centre had been introduced to improve the appointment booking process. By 2016, between 80% and 90% of patients attending the hubs were recorded as self-referrals, presumably because they had used the call centre. The number of referrals from NHS 111 had remained more stable and generally not increased as new hubs opened.
  • The hubs had adapted to lower demand on Sundays by reducing opening hours and staffing, thus ensuring that Sunday usage rates were comparable to usage rates on other days of the week.
  • Some staff working at the hubs raised concerns about their lack of access to patients’ medical records and their inability to refer patients on for further treatment. Both these areas require effective systems to be in place to avoid the potential of increased clinical risk.
  • Survey responses from staff working at the hubs revealed a largely positive attitude towards working at the hubs, with 59% of staff saying that working at the hubs was better than their other or previous work.
  • It is possible that the hub scheme may have had an effect on the locum market in the area: some staff not working at the hubs suggested that higher locum rates being paid to hub staff might reduce the availability of locums for in-hours work.

Full report:
Improving access out of hours: Evaluation of extended-hours primary care access hubs

Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

NHS England | November 2018 | Advice line for GPs saves hours of travel for patients and £100k to be reinvested back into NHS

The Walton Centre in Liverpool – the only specialist hospital trust in the UK dedicated to providing comprehensive neurology, neurosurgery, spinal and pain management services-   runs an advice line which means GPs in the Cheshire and Merseyside area can call neuro consultants for fast advice any weekday reducing extra patient appointments. 

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So far the service has received 181 calls 37% were resolved by the GP saving £51,698 which over a year saves around £100k.

Programme Director Julie Riley said: “We want to deliver services closer to home and when patients do come into hospital, support them so they can recover and go home quicker. From a patient point of view, we want to work in partnership with them. We, our consultant colleagues and GPs want to support them in self-management, where appropriate – rather than taking a paternalistic approach.”

Read the full case study at NHS England 

Increasing continuity of care in General Practice

The Health Foundation is supporting five large-scale GP practices and federations to carry out targeted improvement work to increase continuity of care in their practices.

The Increasing Continuity of Care in General Practice programme will explore what continuity of care will look like, considering relationships between GPs and patients, and also examining whether better information and management practices can help increase continuity with the aim of bringing benefits to both staff and patients.

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This programme is inspired by recent Health Foundation research which demonstrated that patients with ambulatory care sensitive conditions who see the same GP a greater proportion of the time have fewer unplanned hospital admissions. The programme has been developed with the advice and support of the Royal College of General Practitioners.

Each project will run for up to two years and each project team will receive up to £250,000 of funding to support the implementation, evaluation and dissemination of findings from their work.

Full story at The Health Foundation

London Hospital pioneers AI technology to reduce patients’ waiting times

University College London Hospitals | May 2018 | Revolutionising healthcare with AI and data science: UCLH and The Alan Turing Institute announces breakthrough partnership today

University College London Hospitals Biomedical Research Centre and the Alan Turing Institute are working in partnership to improve healthcare through artificial intelligence (AI) and data science.

The Alan Turing Institute will use AI and machine learning techniques to enable analysis of large data sets which will identify bottlenecks and barriers, after identification these could be resolved to improve efficiency and reduce patient waiting times.  (via UCLH).
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Professor Marcel Levi, UCLH chief executive, said:

“With ever increasing numbers of patients and ongoing financial pressures, we need to try something different, something innovative, something longer-term.  The partnership with the Alan Turing Institute provides an opportunity to work with the world’s leading data scientists to do just this.

“Imagine a scenario where patients present to A&E with abdomen pain – our standard response is to check bloods, order X-rays or scans and in probably about 80% of cases, discharge for home management.  What, if through analysis of thousands of similar scenarios, we were able to identify patterns in the initial presentation of the 20% with serious conditions, such as intestinal perforation or severe infections? This could enable us to fast track them through to a scan and a swift diagnosis and could support clinical decision making to manage the 80% who need no further clinical input more effectively. Machines will never replace doctors, but the use of data, expertise and technology can radically change how we manage our services – for the better”.

Sir Alan Wilson, Institute CEO of the Alan Turing Institute, commented: “At the Turing we believe that data science and AI will revolutionise healthcare: not only through new technologies, as in the recent break-throughs in image recognition, but also through applying cutting-edge algorithms to the every-day problems facing the NHS such as A&E waiting times and other crucial services. We are very proud to be working with UCLH to begin a multi-year research partnership and driving the outputs of our research forward to deliver real impact across the whole NHS.”

The full press release can be read at University College London Hospitals 

Related:  University College London Hospitals A Research Hospital: implementing research innovation for healthcare improvement 

In the media:

The Guardian London hospitals to replace doctors and nurses with AI for some tasks

Evening Standard London hospital uses AI to cut A&E queues

Daily Mail Major London hospital is replacing doctors with ROBOTS to tackle mounting A&E waiting times and prioritise the sickest patients

Improving the experiences of people who use services

This briefing looks at what the vanguards have been doing to improve the way people experience and interact with health and care services, and shares the lessons that other organisations and partnerships can take from the vanguards’ experiences | NHS Providers

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This final briefing in the Learning from the new care models series highlights how the vanguards are improving the experiences of people using services and their families.

The briefing looks at the work of the vanguards in the following areas:

  • Coordinating care around peoples’ needs
  • Ensuring people receive high-quality care wherever they are
  • Specialist care closer to home
  • Reducing the need to travel
  • Directing people to the right care, faster
  • Supporting people to manage long-term conditions
  • Supporting people to develop self-confidence
  • Tailoring care for people with the greatest needs
  • Making access to urgent care as simple as possible
  • Promoting health and wellbeing among people and communities
  • Helping people connect
  • Supporting carers to stay well
  • Working with people to design services that work for them

Full briefing:
Learning from the vanguards: improving the experiences of people who use services

Learning from vanguards

The NHS Confederation has published the following briefings sharing learning from vanguards:

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Image source: http://www.nhsconfed.org

 

The value of patient organisations

The added value of patient organisations | The European Patients Forum

The objective of this report is to emphasise the contribution of patient organisations in representing and voicing the situation of a specific population that would otherwise not be represented.

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Image source: http://www.eu-patient.eu

Patient organisations are able to help policy-makers understand the experience of living with a disease or a condition. They use this ‘end-user perspective’ to promote the interests of patients at all stages of policy development and in a range of institutional settings.

The main activities of patient organisations are set out in four different areas: policy, capacity building and education, peer support and research & development (both health and pharmaceutical).

Full report: The added value of patient organisations