AT A GLANCE
THE CHALLENGE
Demand for same day care in North Sedgemoor Primary Care Network (PCN) in Somerset was exceeding capacity and increasing, with the average patient having one more appointment per year in 2022 compared to 2017. It was difficult to recruit and retain staff, partly due to burn-out – this had led to a 185% rise in locum use in the last five years.
Same day appointments were being taken up for routine problems. Patients in deprived areas had far fewer appointments and were more likely to go to the emergency department than the wider patient population. There were opportunities for collaboration across the PCN.
WHAT THEY DID
The CLEAR national team completed a three-day site visit and spoke to 49 staff from the network’s five GP practices, community teams, the neighbourhood board, minor injuries unit and the integrated care board.
They combined the information from the interviews with detailed analysis of five years of PCN data for over 64,000 patients, 1.1m appointments and 3.6m consultations.
CLEAR RECOMMENDATIONS
A complete service redesign with collaborative working across the PCN, a single point of access, enhanced triage and the creation of a central, integrated same day care hub. The CLEAR team recommended that the hub be staffed by a multi-disciplinary team including first contact practitioners, advanced clinical practitioners and physician associates – optimising the additional roles reimbursement scheme (ARRS), with GPs in a consulting role.
Specialists hubs were among other key recommendations including a mental health hub offering 30 minute appointments with trained mental health practitioners and a women’s health hub providing holistic, integrated care.
A nurse-led skin clinic could be created using artificial intelligence to support the assessment of skin lesions. Acute services in ophthalmology and pharmacy could be optimised and musculoskeletal specialists with the skills to diagnose, advise and manage conditions could be integrated across the PCN.
FORECAST IMPACT
Patient satisfaction would improve and health inequalities be reduced through increased equity of access to appointments. Patients would benefits from longer appointments in the specialist hubs, with women’s health appointments up to 60 minutes.
GP consultations would reduce by around 43,000 per year – equating to just over eight whole time equivalent GP roles which would no longer be needed, with a cost saving of between £231,000 and £2.2m depending on the ratio of locums to salaried GPs.
Around £92,000 savings per year could be achieved through better PCN collaboration and enhanced use of established acute services. Workforce diversification and the optimisation of ARRS roles would help boost staff morale, recruitment and retention.
