New access models

National General Practice Improvement Programme (GPIP)

As part of the Delivery plan for recovering access to primary care, NHS England is supporting general practice to implement modern general practice through the National General Practice Improvement Programme (GPIP).

The programme provides support for practices and primary care networks (PCNs) over two years (2023-2025) to make changes and improvements to how they work.

There are four levels of support:

• Universal offer
• Practice support level offer
• PCN offer
• Capability building

This PDF document provides a quick overview of GPIP and describes the levels of support in more detail.

You can also find out more on the NHS website.

See the resources section below for information about how to join the FutureNHS community and view details about how to access the General Practice Improvement Programme.

Greater Manchester Primary Care Provider Board’s PCN Development Programme offers primary care professionals in Greater Manchester the opportunity to share learning and good practice. Its content has been designed to meet needs expressed by PCNs, and is in line with the Greater Manchester Primary Care Blueprint, the Integrated Care Partnership (ICP) Strategy and the national Fuller Stocktake Report.

The details for our 2024/25 programme are currently being finalised. Further information will be published on the PCN Development Programme page as soon as it becomes available.

General Practice Improvement Programme

FutureNHS provides a number of practical resources, webinars and ‘how to’ guides about the modern general practice model and General Practice Improvement Programme (GPIP), including:

• Recording and slides for Modern General Practice Model webinar
• Recording and slides for navigating ‘how to’ guides and the General Practice Improvement Programme
• Guidance for improving general practice websites
• GP website benchmarking and improvement tool
• Top tips for supporting digital inclusion in general practice
• Administrative triage using digital tools in general practice

To access the resources, you will need to sign up to the Primary Care Improvement Community (PCIC) workspace on FutureNHS. PCIC is a national community open to anyone who is interested or involved in quality improvement in primary care.

This PDF provides information about how to join the PCIC community, or you can sign up directly on the FutureNHS website.

NHS guides and resources

A range of guides and resources to support modern general practice can also be found on the NHS website, including support to: 

• better align capacity with need 

• improve care navigation 

• improve telephony journeys 

• improve care-related processes

The guides provide know-how and learning from practices and primary care networks (PCNs) across the country about tested new systems, processes and approaches that are helping the transformation to modern general practice.

They also complement the existing ‘creating highly usable and accessible GP website for patients’ guide.

Optimising Access Through Human Fit (OATH)

Researchers from The University of Manchester have worked with patients and general practice staff to create resources that can help people think about access in a different way.

Find out more and access a range of resources on the OATH website.

How a new shared urgent appointment system is reducing demand in Salford

Case study summary

Eccles and Irlam PCN in Salford has introduced a new referral system to provide urgent same day appointments across the PCN. This has increased the number of routine appointments available, reducing pressure on practices and improving staff morale.

Background

Eccles and Irlam PCN consists of seven GP practices serving a population of approximately 80,000. The PCN is spread across a wide geographical area with varying demographics, ranging from older residents in Irlam, to a more diverse population in and around Eccles.

Like many practices across the UK, demand has increased over the last few years due to a combination of factors including the COVID-19 pandemic, waiting times for secondary care, population growth, reduction in staff and more patients presenting with mental health issues.

What is the new system?

Back in 2021 the PCN, supported by Salford Primary Care Together CIC, used money from the Winter Access Fund to develop a trial urgent appointment system, run through EMIS, which they called Additional Care Today (ACT). The system was utilised in all seven GP practices across the PCN to provide urgent same day appointments. Due to its success, the system has now been implemented on a permanent basis.

How does it work?

If a patient requiring an urgent appointment is unable to be seen on the same day at their own GP practice, trained reception staff can access the ACT system to book an appointment at another practice within the PCN. Before allocating an appointment, reception staff run through a number of clinical questions generated by the ACT system to ascertain if a same day appointment is necessary.

Depending on demand in the system, the service can offer anywhere between 33 and 99 additional appointments a day.

Clinicians from across the PCN work on a rota basis to provide a triage service to patients referred through ACT and, if needed, the patient is then offered a same day appointment at a practice within the PCN.

The system is monitored on a regular basis to ensure only appropriate appointments are booked through ACT. For any that aren’t considered urgent, this is fed back to the relevant GP practice for training purposes.

What are the benefits?

The ACT system has freed up a number of routine daily appointments across the PCN.

Patient satisfaction has improved and pressure on reception staff has also reduced as patients are reassured by the fact that they are able to get a same day appointment if needed.

Patients who otherwise may have called 111, or presented at A&E, are now being seen by a GP on the same day.

How new ways of working are boosting patient experience and improving staff wellbeing at a Wigan GP practice

Case study summary

Dr Nikesh Vallabh, GP partner at Hawkley Brook Medical Practice and clinical director for SWAN PCN, explains how the introduction of a single point of access and new triage system has improved patient access and allowed more time to focus on staff wellbeing and development.

Background

Hawkley Brook Medical Practice is one of eight practices in the SWAN Primary Care Network, based in North Wigan. The practice has three GP Partners serving around 3,000 patients.

Historically the practice has a high number of elderly patients, many with multiple health needs requiring longer appointment times or home visits.

The impact of COVID-19

Dr Vallabh joined Hawkley Brook Medical Practice in December 2020 at the height of the COVID-19 pandemic, taking over from a previous GP Partner who retired after 35 years of service.

In 2021 the practice team was joined by learners including GP trainees and foundation doctors, followed by an additional partner, Dr Luke, in 2022.

As with many other practices across the UK, the onset of the pandemic saw the practice move to an online booking system and alternative consultation methods.

Dr Vallabh said: “Our patients learnt to accept new ways of working, not just because of the pandemic, but also because of the changes in GP staff, in particular the retirement of the long-standing partner who had traditionally been their go-to.

“We saw this as an opportunity to continue to develop new systems and move away from the traditional model of access with patients phoning to book a limited number of appointments, often weeks into the future, resulting in longer waiting times and backlogs of work.” 

Hawkley Brook Medical Practice and SWAN PCN

Hawkley Brook Medical Practice is one of eight practices in the SWAN Primary Care Network (PCN). Together they serve a total population of around 37,000. Five of the practices, including Hawkley Brook, are based in one multi-purpose health centre.

SWAN PCN offers each practice access to a number of weekly appointments, including First Contact Practitioner (FCP), mental health, pharmacist, social prescribing and care coordinator appointments. These are allocated to practices based on their list size and booked through an internal PCN booking system, ensuring all patients have equal access to services.

How the new access and triage systems work for Hawkley Brook

The practice chose to introduce one single point of access – Ask My GP – with all patients required to contact the practice this way. For those that can’t, or don’t want to use the system, patients can ring the practice and a member of the admin team will complete the online form on their behalf.

The practice allows patients to access Ask my GP between the hours of 6.00am and 5.30pm, with patients able to submit a request any time up to and including 5.30pm. Requests are dealt with via a triage system, whereby the reception team filter out anyone not requiring an appointment, for example patients requesting a repeat prescription.

Appointments are then allocated equally to each GP partner who triage the referrals through Ask My GP and book an appointment with the relevant practitioner – this could be a GP partner, trainee or with another service such as social prescribing or pharmacy.

Dr Vallabh said: “Allowing patients to use Ask My GP at any time of day has offered patients more flexibility. This, combined with our improved triage system, has resulted in the number of patients needing an appointment with a GP Partner reducing significantly, allowing more time to focus on patients with multiple health needs. As GPs we now have the flexibility to offer longer appointments times outside the standard ten minutes.”

Benefits for patients

The practice guarantees that all patients will have contact from the practice on the same day and/or see a doctor for all routine and urgent requests, with an average turnaround time of 37 minutes from the point of patient contact to receiving a message from the practice.

Patients with multiple health issues have time to discuss their health needs without being limited to a ten-minute appointment.

In the 2023 national GP Patient Survey, Hawkley Brook received the second highest overall patient satisfaction result in Greater Manchester at 98%.

Additionally, the practice has virtually no DNAs (Do Not Attends) compared to other practices in the area.

Benefits for staff

GPs at the practice start each working day afresh, with no backlog of patients waiting to be seen. The new system has allowed for more flexibility, with partners able to stagger start and finish times to suit their needs and spend more time on staff development, with learner tutorials taking place every Friday, daily staff huddles and regular practice meetings.

Hawkley Brook recently became the first health and care organisation in Greater Manchester to become a member of the Greater Manchester Good Employment Charter. They also won Employer of the Year at the 2023 Greater Manchester Health and Champions Awards for their commitment to staff wellbeing and career development.

Future plans

Hawkley Brook is currently working with the Shakespeare Practice, also part of SWAN PCN, to develop a joint triage system which will work across both practices.

Dr Vallabh said: “It’s hoped that a joint triage system will free up even more time for GPs and staff across both practices, allowing greater flexibility and a better experience for patients.

For more information visit Hawkley Brook Medical Practice website.

Changing access models in general practice

In an episode of the Primary Care Knowledge Boost (PCKB) podcast, doctors Sara and Lisa talk to GP, Dr Adam Cliffe, from Lockside Medical Centre in Stalybridge, about how he and his practice changed the model by which patients access the practice.

The podcast is a good example of change management and how a difficult situation was changed for the better.

You can access the podcast on our resources website page.

How Middleton PCN has increased appointments by opening a health hub in a local shopping centre

Case study summary

Kate Fisher, Digital and Transformation Lead for Rochdale Health Alliance, explains how Middleton PCN has improved patient access and increased the number of weekly appointments across the PCN by opening a unit in the local shopping centre.

Background

Middleton PCN consists of seven GP practices, serving a population of around 46,620.   The PCN recently recruited 38 ARRS staff to provide additional services across the PCN such as physiotherapy, social prescribing, mental health support, phlebotomy and pharmacy appointments.  

Kate said: “The main challenge facing Middleton PCN was the lack of space to house our ARRS staff. All seven practices in the PCN are based in individual buildings with rooms already occupied by existing clinical and non-clinical staff. Many of the buildings have limited parking and poor public transport links, resulting in patients waiting longer than necessary for routine appointments.”

Creating a new space 

The idea to rent a space in the local shopping centre was conceived by PCN Clinical Director, Dr Mo Jiva. Once approved, monies were pooled together by the PCN, Rochdale Health Alliance, and Public Health to rent a unit based in Middleton shopping centre.  

With six consultation rooms, a daily footfall of approximately 50,000, free parking and proximity to the local bus station, the hub is an ideal location to create a centre from which routine appointments can be offered to patients from all seven GP practices. It also provides an opportunity to promote public health campaigns and sign-post residents to other services.

How the hub has benefitted staff and patients 

Routine appointments for things such as blood tests, physiotherapy and pharmacy are available daily at the hub. This has resulted in reduced waiting times across the PCN and freed up approximately 100 GP appointments per week.  

Trained care co-ordinators based on the hub reception are able to sign-post members of the public to other services and visibility of the hub has also created an opportunity to promote the PCN and build trust with local residents.    

Significantly, the hub provides a space for staff across disciplines to work together to support patients and have important health conversations with people who may have otherwise been missed by their GP.

Kate said: “We recently had a patient attending for a routine blood appointment disclosing some mental health concerns and housing issues to the nurse. The nurse was able to speak to one of the Social Prescribing Link Workers based in the hub and immediately refer the patient for further help and support.”

Future plans 

There are further plans to utilise the space outside the hub to promote wider public health initiatives such as HIV testing and stop smoking services, as well as plans to offer more services, including sexual health sessions.  

How tackling health inequalities and the use of digital technology is reducing demand in Wigan

Case study summary

Simon Carr, PCN Manager at TABA PCN in Wigan, explains how a combination of initiatives to tackle health inequalities and improved use of technology has reduced overall demand and increased the availability of GP appointments across the PCN.

Background

TABA PCN (Tyldesley, Astley, Boothstown and Atherton) consists of 11 GP practices, serving a patient population of 56,000 located in the south-east corner of Wigan Borough.  

Although each of the eleven practices is located within a relatively small geographical area, the population demographic varies considerably from practice to practice with pockets of deprivation in close proximity to areas of affluence.

Tackling health inequalities 

The PCN has implemented a number of initiatives to tackle health inequalities, one of which involved working with the charity MIND to increase the uptake of Severe Mental Illness (SMI) health checks. Staff from MIND spent two to three weeks in each practice contacting patients on the SMI health check register to discuss general health concerns, whilst encouraging them to come forward for an SMI health check.

Simon said: “We found that patients were much more open to discussing their health with volunteers and staff from Manchester MIND who used a more holistic approach to tackle problems affecting a patient, from housing issues to money worries as well as physical and mental health concerns. This led to further discussions about the benefits of SMI health checks leading to an increase in the uptake of health checks across the PCN.”

The project with MIND also coincided with the acquisition of two new Point-of-Care (POC) blood test machines which could be rotated around practices in the PCN. The blood test machines provided two types of blood tests – hemoglobin A1c (HbA1c) and lipid testing – both important elements of a health check. Historically the PCN found it difficult to get patients to have these blood tests as they were only done at Leigh Infirmary which for many patients was difficult to access, often resulting in no-shows and this part of the SMI health check being incomplete.

Overall the project with MIND, alongside the availability of the two POC blood test machines, resulted in over 200 SMI health checks being completed during 2022-23, a 30-35% increase on the previous year.

Additionally, the PCN has worked with local communities to increase access in areas where patients are traditionally hard to reach. One such initiative saw TABA PCN working with a community café to place health staff within the café.

Simon said: “Initially staff went to the café and joined activities alongside local residents. This was done in order to build trust with people attending the cafe, eventually leading to a nurse and Trainee Nurse Associate running health clinics from the café, providing hypertension and NHS health checks.”

Sadly, the café has since closed, however TABA PCN has replicated the model with a current base in Atherton town hall where there is a library and café providing drop-in services based around the PCN priorities of hypertension and NHS health checks. A Trainee Assistant Psychologist has also recently been placed in the town hall to support patients with mental health issues.

The PCN is currently investigating options to run further satellite clinics in other locations, such as local supermarkets.

How digital technology is helping the PCN to provide more appointments

In January 2020, the PCN introduced a new IT system – GP Connect – from which all practices across the PCN can book ARRS appointments, including phlebotomy, physiotherapy, First Contact Practitioner (FCP) and mental health appointments.

GP Connect was developed from the existing EMIS system which was already used by all practices across the PCN from which they were able to develop a PCN EMIS clinical hub.

By utilising the central EMIS clinical hub and GP Connect, the PCN has been able to maximise its estates and is able to offer appointments to registered patients from each of its clinical locations. Clinical staff can access full patient records from any location meaning patients can choose where to attend a service or clinic. This has led to more collaborative working, as well as working at scale and equity of availability. Importantly, it has also saved clinical time with less travel for clinical staff between each location.

The PCN has further developed the use of AccuRX, a system initially used at the start of the COVID-19 pandemic, to offer messaging and video capability. The additional functionality means that text invitations can be linked to set clinics or clinicians, allowing patients to select a day and location to suit their needs. This has allowed the PCN to expand the types of clinics patients are able to book in advance, such as health checks and diabetes clinics. Overall, it has helped to increase activity and reduce the number of DNAs (Do Not Attend).

Overall benefits

Community initiatives to improve patient accessibility, combined with new technology allowing patients more choice to book routine clinic appointments at a location of their choice, together with the availability of ARRS appointment, has increased the overall availability of both routine and urgent GP appointments at each practice across the PCN.

Since April 2023, for example, 400 health checks have already been completed, freeing up the number of future appointments available for patients.

Simon said: “By diverting patients away from practices to other locations, in some instances where they are able to book a future appointment, for example a diabetic clinic, we have improved accessibility and reduced demand on GP practices, freeing up the number of routine and urgent appointments available each day.”

Wigan PCNs take to the leisure centre in liver screening pilot

Case study summary

Mike Shinks, a nurse at Wigan Borough Federated Healthcare Ltd, explains how running a national liver pilot from a Wigan leisure centre enables him and his team to offer a more holistic service to patients.

Background

Wigan Borough Federated Healthcare Ltd supports two Primary Care Networks – Wigan North and Wigan Central, which cover a total of 13 GP practices.

During the pandemic they worked with Wigan Council, which runs Robin Park Leisure Centre, to deliver Covid vaccination clinics in the heart of the community.

The relationship has continued and the leisure centre has converted some of its rooms to accommodate regular NHS Health Check clinics on behalf of the two PCNs.

These operate five days a week between 8am and 8pm, and are proving popular with patients as they are in a location and at a time to suit them. This arrangement also takes some of the burden off GP surgeries.

When NHS England sought applications for its national initiative to check for liver cancer in high-risk communities, Wigan Borough Federated Healthcare Ltd put forward the idea of operating the pilot from its leisure centre clinics.

Only one in three liver cancers are diagnosed at an early stage but if caught early, patients have a 70 to 90 per cent chance of survival for five years or more with treatment.

How it works

The team at Wigan have identified patients who meet the following high-risk criteria: an alcohol consumption of more than 30 units per week, diagnosed with a fatty liver, with a BMI of more than 30, or with type 2 diabetes.

They contact people by text message, inviting them for a chat about their liver health, and of the 6,300-plus people approached so far, around 19 per cent responded.

Patients are invited to the leisure centre clinics for a FIB 4 blood test, to check for their risk of fibrosis in the liver.

Twice a week, blood samples are sent off to the phlebotomy labs at Warrington and Halton Teaching Hospitals NHS Trust via the Greater Manchester Blood Bikes charity.

The clinical team at Robin Park can access the results first thing the following morning and if necessary, they can invite the patient in for a scan later that same day.

The portable scanner, which is on loan from NHSE for the duration of the pilot, is around the size of a laptop so assessments can take place in the clinic rooms in under 30 minutes.

Results and further action can be discussed immediately.

In some cases, patients are referred to secondary care hepatology and placed on the hepatocellular carcinoma (HCC) pathway for liver cancer. In others, they are referred for an Enhanced Liver Fibrosis (ELF) test.

Where patients don’t require further assessment or treatment, the clinical team take the opportunity to offer lifestyle advice where appropriate.

Benefits for patients and staff

Although patients are invited based on high-risk factors, they are showing no symptoms.

If unchecked, a damaged liver can go beyond the point of repair. However, if the risk of damage is known, many cases can be turned around with a healthier approach to alcohol and food.

Mike said: “Even if a scan delivers a good result, we can chat about the benefits of making lifestyle changes. The Health Check training kicks in and we have the time to chat properly, and people talk more openly to us.

“Located where we are means we can offer a wraparound service. We can recommend people to look at the Be Well Wigan website for lifestyle advice, and where necessary, refer them to the We Are With You drug and alcohol charity.

“Being based in Robin Park means we can even show them around the leisure facilities and gym!”

One patient said: “The liver blood test was something that I wasn’t aware about and if you can catch any disorder early that’s good and can be treated.”

Future plans

The pilot runs until the end of December and final results are expected next spring. So far, the team have referred 88 people to the HCC pathway.

The team is following up with those people who have yet to respond and if the pilot was to continue they plan to look at other ways of reaching those at risk.

They would love to keep hold of the scanner for a longer period of time, if possible, and can see the potential of extending assessments in the wider community.

Mike added: “It’s a hand held scanner, about the size of a laptop, so we could go into care homes and do home visits.”