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Our Extra Care service has become a lifeline for local practices and patients

by Rachel Carter
8 June 2018

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The Gateshead Extra Care service, set up to increase flexibility around GP appointments, has become a local lifeline, says Anna Sives, practice development manager at CBC Health Ltd.
“For the staff at the front end, it’s reduced a lot of the pressure they had from patients being upset when they can’t access a GP on the same day – and for patients, it’s another choice,” she says. 
The service was set up in September 2015, after successfully securing funding from the Prime Minister’s Challenge Fund, and offers GP appointments seven days a week. By March 2017, it had seen 20,269 patients, with a utilisation rate of 87%. The team were recognised for their work at last year’s GP Awards, winning the GP Forward View Innovations for Productive Workflows category.
“At the time, the government gave the indication that they wanted practices to be open from 8am to 8pm and initially we started to explore whether individual practices could do it,” Ms Sives says.
“But a wider discussion decided that wasn’t possible or cost-effective, and a densely-populated area like Gateshead would actually benefit from a hub-style service.”
Choice and flexibility
The Extra Care service is now made up of two hubs, (originally there were three), one in central Gateshead, and the other at Blaydon practice, in the outer-west part of town.
Gateshead has a patient population of 201,000 and the Extra Care service is supporting people from 31 practices. They ring their own registered GP surgery to make an appointment. The receptionist at each practice has access to book them into the Extra Care schedule, which offers appointments from 8am to 8pm Monday to Friday, and 9am to 5pm Saturday and Sunday.
“It’s given that choice to a lot of patients who work or have caring responsibilities – I’ve noticed some patients just phone up and want to always book in for Extra Care now,” Ms Sives says.
The only patient groups the service doesn’t offer appointments to is those with complex mental health issues and anyone that the GPs know are going to need a referral onto other services.
“If someone is just feeling a little bit low then they can be seen, but if it’s quite complex then we felt that the continuity of care is still important from the GP in their own practice,” Ms Sives adds.
“Not being able to see patients who we know are going to need a referral is an ongoing challenge – and that’s because the technology just isn’t there yet, so that’s why there’s an exception.”
Technical challenges
Ongoing technical challenges have been the only negative of setting up the service, Ms Sives says, but the clinical system EMIS, which is used by everyone involved, has been a good thing.
“In order to run a service like this a clinician needs to have access to some medical records, so EMIS is a good system for that in terms of inter-operability. Once the patient is in the room, the GP can view their medical records, do prescriptions, whatever they need – so it’s really slick.”
When the NHS cyber attack happened last year, the service was also able to avoid disaster because EMIS had been set up on managers” laptops to be used anywhere, Ms Sives adds.
“We just mobilised our laptops to the Extra Care clinics so the doctors were able to continue consulting, while the networks within the practices were all down and being switched off,” she says. ‘So that was another kind of ‘tick, yes, we got that right” and we didn’t have to turn patients away.”
Supporting others
One real positive of the service, Ms Sives adds, is that it offers GPs the opportunity to work in a different environment and add to their existing portfolio. The service employs its own doctors and has sessional GPs coming in, some of whom work for local practices, but “we don’t rely completely on that, because a lot of full-time GPs are on their knees now,” she says.
“I personally feel that GPs struggle to do a full-time job in a practice now because it’s so exhausting, so giving the opportunity to do an extra-care or out-of-hours session is actually better for their health and ultimately better for the patients because you’ve not got a worn-out GP.
“Some of the GPs choose to work just in the extra-care system, for example, if they’ve decided that they’ve done their time in general practice and want to just focus on the day to day.”
The service, which has recently had ongoing funding approved by the CCG, has itself been driven forward by three GPs, two of whom are still “jobbing GPs” in the local area, Ms Sives says. It’s also been one of the first examples of an “at-scale” model, with membership from every practice.
“We feel that’s the key really,” she adds. “Our directors are passionate about the services in Gateshead and it’s a bit of a family in some respects – it’s all about supporting practices, supporting patients, and us all working together for the same aim.”
To enter this year’s General Practice Awards click here.
When was the service set up and who runs it?
September 2015. The service is run by CHC Health Ltd, a not-for-profit organisation.
How is the service funded?
The service was set up using funding from the Prime Minister’s Challenge Fund, a pot of money made available to help projects that improve access to primary care and demonstrate innovative ways of providing primary care services. The CCG has recently approved ongoing funding.
How did it feel to win the award?
“We didn’t expect it – were were just enjoying the evening and we even hesitated when they called our name, so it was a bit of a shock to the system. But it’s been really positive for us and having the team and the service recognised is very important,” says Anna Sives. 
Rachel Carter is a freelance journalist
Want to enter this year’s General Practice Awards?
This year’s General Practice Awards are now open! As well as the Practice Manager of the Year Award category we have two new NHS England sponsored categories available:
The Collaboration with Patients and Other Providers Award
This award seeks to recognise a practice/group of practices who have developed new collaborative ways of working with patients and other organisations, to improve care or introduce new services.
The Managing Workload and Improving Access Award
This category looks to recognise the work of a practice/group of practices who have released staff time or improved access for patients through using the 10 High Impact Actions to release time for care.
If you are interested in entering, visit our website for more information.