National Review of Access to General Practice Services in England: - - PowerPoint PPT Presentation

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National Review of Access to General Practice Services in England: - - PowerPoint PPT Presentation

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National Review of Access to General Practice Services in England: Patient and public participation event Tuesday 20 August 2019 Slides and feedback NHS England and NHS Improvement Welcome and introductions Alison Dickinson, Programme Lead,

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NHS England and NHS Improvement

National Review of Access to General Practice Services in England: Patient and public participation event

Tuesday 20 August 2019 Slides and feedback

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Welcome and introductions

Alison Dickinson, Programme Lead, Improving Access to General Practice Liz Vickerstaff, Programme Lead, Improving Access to General Practice Olivia Butterworth, Head of Public Participation

National Access Review to General Practice Services in England

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Agenda

10.00am Registration and networking 10.30am Welcome, purpose of day and introductions Alison Dickinson, Programme Lead, Improving Access to General Practice, Liz Vickerstaff, Programme Lead, Improving Access to General Practice, and Olivia Butterworth, Head of Public Participation, NHS England and NHS Improvement 10.50am Current experiences of accessing general practice services Open discussion 11.20am Access to general practice – what does good look like for you? Open discussion 12.15pm Lunch 1.15pm Who else/what else can support good access to general practice? Facilitated table discussions 1.45pm Continuity of care – what does this mean to you? Facilitated table discussions 2.15pm What’s the review about and reflections so far Dr Raj Patel, Deputy Medical Director for Primary Care, NHS England and NHS Improvement Followed by panel discussion and Q&A 2.45pm Break 3.00pm Final thoughts: top 5 recommendations 3.45pm Next steps and close 4.00pm Close

National Access Review to General Practice Services in England

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National Review of access to General Practice services in England

Liz Vickerstaff, Programme Lead -

Improving Access to General Practice

National Access Review to General Practice Services in England

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  • Patients views and needs are changing
  • Level of investment in general practice not increased
  • Morale and job satisfaction at its lowest since 2001
  • General practice and primary care needed to change
  • So, what are we trying to do….

Why are we looking at access to general practice?

National Access Review to General Practice Services in England

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Current experiences of accessing general practice services

National Review of Access to General Practice Services in England

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How satisfied are you with General Practice? Voting Results.

1.Very satisfied 2.Satisfied 3.Somewhat satisfied 4.Not satisfied 5.Not at all satisfied

National Review of Access to General Practice Services in England

1.Very satisfied 2.Satisfied 3.Somewhat satisfied 4.Not satisfied 5.Not at all satisfied

14% 29% 38% 17% 3%

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1. How do you access general practice services? 2. What do you do if you can’t get an appointment - what other health services

  • r groups do you use?

Current experience of accessing general practice – discussion

National Review of Access to General Practice Services in England

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  • Patient
  • In person
  • Telephone – triage system / ring on day
  • Online
  • Wait to see own GP
  • Email
  • Queue at door
  • Patient and carer
  • Book online
  • Go to surgery in person
  • Telephone

How do you access general practice? Responses (themes) #1

National Review of Access to General Practice Services in England

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  • Patient and health and care professional
  • Online booking
  • Telephone (triage system)
  • Drop-in (in person)
  • Ring for emergency appointment
  • Queue outside practice
  • Practice contacts me (long term condition)
  • Something else
  • Ring for same day appointment / triage
  • Sit and wait
  • E-consultation or telephone consultation
  • Use online booking
  • Telephone
  • In person (sit and wait)

How do you access general practice? Responses (themes) #2

National Review of Access to General Practice Services in England

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How do you access general practice services? Voting Results.

1.Phone 2.Sit and wait/queue 3.On-line appointments/prescriptions 4.Call 111 (to access a GP) 5.Do nothing

National Review of Access to General Practice Services in England

53% 15% 30% 0% 3%

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  • Patient
  • Go to community pharmacy
  • See pharmacist at practice
  • Call 111
  • Complain
  • Wait for an emergency appointment / ring on the day
  • Use a health apps
  • Visit surgery to get an appointment
  • See a private doctor
  • Self-care
  • Go to urgent treatment centre
  • Go to A&E
  • Don’t go
  • Patient and carer
  • Go to Urgent Care Centre
  • Self care (use rescue medicines)
  • Ring 999 (if urgent)
  • Ring 111

What do you do if you can’t get an appointment? Responses (themes) #1

National Review of Access to General Practice Services in England

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  • Patient and health and care professional
  • Go to GP hub or walk-in centre
  • Self-refer e.g. to physio
  • Go to out of hours service
  • Ring and keep ringing at 8am
  • Something else
  • Ring 111
  • Self-care
  • Go to GP hub
  • Go to local pharmacy
  • Go to A&E
  • Change my GP
  • Use out of hours GP services
  • Put up with it
  • Complain
  • Go to private GP

What do you do if you can’t get an appointment? Responses (themes) #2

National Review of Access to General Practice Services in England

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What do you do if you can’t get an appointment? Voting Results.

1.See the pharmacist 2.Use health app/go online for information 3.Ring 111 4.Go to A&E 5.Self-care 6.Go to urgent care centre/walk in centre 7.Do something else

National Review of Access to General Practice Services in England

8% 9% 15% 8% 16% 19% 25%

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  • (More) information about what different professionals do.
  • Educate patients about which service or professional to see.
  • Easily / consistently available interpretation services.
  • Being treated as soon as possible.
  • Supportive / helpful receptionists.
  • Accessible surgeries.
  • Not having to queue.
  • Having more appointments available.

What would improve access? Responses (themes)

National Review of Access to General Practice Services in England

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What is the most important thing for you regarding access? Voting Results.

1.Can get an appointment when I ‘phone 2.Effectiveness/appropriateness of triage 3.Not having to queue 4.Seeing a doctor / GP 5.Seeing someone on the same day 6.Being able to sit and wait

National Review of Access to General Practice Services in England

37% 18% 11% 23% 9% 3%

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Access to general practice – what does good look like for you?

National Review of Access to General Practice Services in England

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  • 1. What are the barriers or challenges to

accessing general practice?

  • 2. Who do you expect to see?
  • 3. How quickly do you expect to be seen?
  • 4. What is the outcome you want?
  • 5. How do you make decisions about when,

how, who you see?

  • 6. Is the type of access – ‘phone, video, face to

face, online – important?

Access to general practice – what does good look like for you? Discussion

National Review of Access to General Practice Services in England

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  • More use of pharmacists.
  • (Re-)direction of patients to appropriate services (including from A&E).
  • Timely access to appropriate professional.
  • Self-referral e.g. to physiotherapist.
  • Additional / more diverse practice workforce.
  • Education of receptionists.
  • Education of patients / public (including about different options).
  • Improved IT skills (professionals and patients).
  • More volunteers in General Practice.
  • Communication.
  • Access to own medical records and online booking / prescriptions.
  • Home visits when needed.
  • Easy to get urgent GP appointment.

What does good look like? Responses (themes) #1

National Review of Access to General Practice Services in England

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  • Good triage system.
  • Good services available locally.
  • Choice of doctor / healthcare professionals.
  • Choice of different type of appointment (face-to-face / ‘phone / online).
  • Better online services.
  • Recognition of people who aren’t online / support.
  • Having a Patient Participation Group (PPG).
  • Right ratio of GP to patients.
  • Continuity – especially for long term conditions.
  • Support for carers – priority access to appointments.
  • Addressing barriers to registration with a GP practice.
  • Accessible information and communication.
  • Access to interpreters.

What does good look like? Responses (themes) #2

National Review of Access to General Practice Services in England

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  • Flexible appointment length.
  • Access to same-day appointments (where appropriate).
  • Appropriate referrals.
  • Able to get appointment with ‘own’ GP / same professional.
  • Annual reviews.
  • Being able to see an appropriate expert e.g. asthma nurse.
  • Person-centred / personalised care.
  • Address transport issues.
  • Additional diagnostics available at GP Practice.
  • Sufficient appointments to meet demand (day / evening / weekends).
  • Being able to see a doctor within 2/3 days.

What does good look like? Responses (themes) #3

National Review of Access to General Practice Services in England

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What would make the biggest improvement? Voting Results.

1.Access to medical records/ appointments/ prescriptions online 2.Seeing the same professional 3.Consistent services at all general practices 4.Self-referral without seeing a GP 5.Appropriate triage and timely access 6.Something else

National Review of Access to General Practice Services in England

6% 26% 18% 12% 32% 6%

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1.Longer appointments 2.Information in a format I can access 3.Communication professional available for my appointments 4.GP practice staff able to communicate with me 5.All of the above 6.None of the above

How should general practice respond to your individual needs? Voting Results.

National Review of Access to General Practice Services in England

23% 3% 2% 9% 45% 19%

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Who else/what else can support good access to general practice?

National Review of Access to General Practice Services in England

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  • 1. Is seeing a GP first important?
  • 2. Who else have you booked an appointment with?
  • 3. Who else would you want to see?
  • 4. Activity: Map out all the different people that you may want to

see/be able to see and when this would be the case. Roundtable conversations – drawing out: social prescriber / link worker; advice worker; physiotherapist; nurse; pharmacist.

  • 5. In what circumstances would you see these different people?
  • 6. What are your experiences of seeing other health care

professionals in general practice? Are they positive, have you had any negative experiences?

  • 7. Are there other people who you could see for concerns if they

were easily available e.g. money advice for anxiety around debt worries?

Who else/what else can support? Discussion

National Review of Access to General Practice Services in England

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  • Phlebotomist (blood tests).
  • Osteopath.
  • Sexual health services.
  • Mental health support / services / counsellor.
  • Advocacy.
  • Citizens Advice Bureau (CAB).
  • Dietitian.
  • Podiatrist.
  • Audiologist.
  • Dermatologist.
  • Occupational therapist.
  • Advanced nurse practitioner.
  • Paramedic.
  • Patient education including self-referral and awareness of services / professionals, and self-

care (communication).

Who else / what else can support? Responses (themes) #1

National Review of Access to General Practice Services in England

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  • Specialist clinics (e.g. flu, asthma, diabetes, baby, eye).
  • Older care expertise.
  • Self-help groups.
  • Smoking / drug / alcohol services.
  • Social prescribing / care navigators.
  • Accessible information.
  • Carers assessments.
  • Community pharmacists.
  • Proper triage.
  • PPGs.
  • Midwives / health visitors.
  • Self-referral (e.g. physiotherapist, mental health).
  • Right professional to make diagnosis.
  • ‘One stop shop’.
  • Social worker.

Who else / what else can support? Responses (themes) #2

National Review of Access to General Practice Services in England

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Continuity of care – what does this mean to you?

National Review of Access to General Practice Services in England

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  • 1. What does continuity of care mean to you?
  • 2. Does continuity of care mean seeing the same

person or ensuring whoever you see know about your medical history/condition?

  • 3. Is continuity important to you?
  • 4. Is this more important for some people with specific

needs / conditions?

  • 5. Is it just about the GP or is it about having someone

who knows you e.g. care co-ordinator?

  • 6. Is it another health professional that’s more

important?

Continuity of care – discussion

National Review of Access to General Practice Services in England

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  • Clear record keeping.
  • Not having to repeat your story.
  • A professional who knows you / continuity of professional.
  • Different specialists for different conditions.
  • Someone who is able to communicate with you as an individual.
  • Support for carers.
  • Role of care coordinator in ensuring continuity of care.
  • Regular reviews.
  • Continuity of pre- and post- hospital care.
  • Care planning for long term conditions.
  • Sharing records.
  • A professional with a holistic overview of the individual.
  • Including social care with health care.
  • Especially important for older people and children, and people with a learning disability.

Continuity of care – responses (themes)

National Review of Access to General Practice Services in England

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What’s the review about and reflections so far?

Dr Raj Patel Deputy Medical Director for Primary Care

National Review of Access to General Practice Services in England

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The national access review

National Review of Access to General Practice Services in England

The national review of access to general practice services has one main objective: to improve patient access both in hours and at evenings and weekends and reduce unwarranted variation in experience A key output will be the development of a coherent access to general practice appointments offer that practices (in hours) and PCNs (outside core general practice hours) will make for both physical and digital services to 100% of patients Plus supporting tasks:

Costs & benefits of current & previous models More joined up services How to support patients & staff make best use of services Engage with patients and public& understand inequalities Best use of appointme nts that

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continuity and choice Care navigation & demand mgmt Understand variations in waiting times Relationship between workforce pressure, wellbeing & delivery Comprehen sive out of hospital

  • ffer

Make best use of resources

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32.8% 11.0% 26.5% 23.8% 5.8% 32.6% 10.4% 25.7% 25.3% 6.0% On the same day On the next day A few days later A week or more later Can’t remember

How long after initially trying to book the appointment did the appointment take place?

2018 2019

Timeliness of appointments

Patient views GP system data

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General Practice Access Fund

Over 17m patients More than 300 access hubs created More than £285m invested 2,500 general practices 24 trialled e-consultations 9 schemes introduced care navigation 17 telephone consultation schemes

57 GP Access Fund schemes

2 roving doctors 13 schemes integrated with 111 24 community pharmacy and Pharmacy First schemes 16 self management and LTC schemes 25 online or web services 14 integrated community care teams

National Access Review to General Practice Services in England

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The access review will:

  • Ensure relevant audiences across general practice, primary care

and the wider system are aware of the national review of access to general practice, understand its objectives, key outputs and scope.

  • Offer patients and the public the opportunity to contribute their

views and experiences.

  • Enable key stakeholders, including general practice teams,

commissioners, and providers to engage with the review and provide feedback based on their own experiences.

  • Connect with key internal and external groups, as part of the

National Advisory Group and Working Group.

  • Facilitate targeted engagement with specific groups who may have

feedback to offer regarding certain aspects of the review e.g. digital specialists and urgent care teams.

  • Ensure any recommendations arising from the review are widely

communicated and understood, to aid implementation. A number of regional and subject specific engagement events have been set up: details of each event can be located here: www.england.nhs.uk/accessreview

Communication and engagement

National Review of Access to General Practice Services in England

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Final thoughts: top recommendations

National Review of Access to General Practice Services in England

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Based on what you’ve heard and discussed today, what is your top issue or recommendation you want us to look at as part

  • f the review?

Top recommendations

National Review of Access to General Practice Services in England

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  • Effective triage.
  • Offering alternatives when an appointment not available.
  • Patient-centred care.
  • Information, education, and communication for patients.
  • Timely access.
  • Work with carers.
  • Support from interpreters / communication professionals, when

needed.

  • Increased mental health support.
  • More GPs.
  • More engagement with different groups.

Your recommendations – responses (themes)

National Review of Access to General Practice Services in England

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Next steps and close

Web: www.england.nhs.uk/accessreview Email: england.accessreview@nhs.net

National Review of Access to General Practice Services in England

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  • We have set up a dedicated email address for the review:

england.accessreview@nhs.net

  • To read more about the review, please visit: www.england.nhs.uk/accessreview
  • If you wish to attend any of our upcoming regional or subject focussed events,

please visit our webpage or email england.accessreview@nhs.net

  • To read the “Investment and evolution: A five-year framework for GP contract

reform to implement The NHS Long Term Plan, please visit: https://www.england.nhs.uk/publication/gp-contract-five-year-framework/

  • Share your views or follow the conversation on Twitter using the hashtag

#accessreview

How to keep in touch and further information