Extending access to routine general practice across seven days had ‘no demonstrable impact’ on either emergency admissions or out-of-hours services, NHS England’s final evaluation of the first £50m wave of pilots has concluded.
Minor illness attendance at A&E departments reduced in 13 of the 20 pilot areas analysed by 14% on average, saving a total £1.9m, said the report.
Of the £60m spent on pilots up until September 2015 (which included central funding and CCG additions), £18m were spent on extended hours, £25m on ‘other enhanced primary care initiatives’ and £17m on infrastructure such as IT and project management.
The average cost per total additional extended hour was around £215, while the average cost per available appointment ‘was typically around £34’.
The analysis, which comes as NHS England has already allocated £6 per patient for all CCGs to roll out GP appointments in evenings and weekends from April 2019, calculated that ‘the annual cost per registered patient to support additional extended hours is £5.60’.
At least £1.5bn will be ploughed into extending GP access by 2021, but the Conservatives will still not be able to deliver 8-8, seven day access to all patients by 2021 in line with their manifesto.
But the report reiterated the advice from the interim evaluation, concluding that ‘given reported lower utilisation on Sundays in most locations, additional hours are most likely to be well utilised if provided during the week or on Saturdays (particularly Saturday mornings)’.
It also said feedback suggested weekend appointment ‘might best be reserved for urgent care rather than pre-bookable slots’.
The report said: ‘As detailed above, 13 of the pilot schemes have collectively seen a reduction in minor attendances at A&E from the date they went live with initiatives up to November 2015, the total reduction of which was 44,400.
‘This would generate a reduction in annual expenditure for commissioners in this service of £1.9 million. This saving would need to be offset against the investment in primary care.
‘For emergency admissions and out-of-hours services, there has been no demonstrable impact and, as such, there are unlikely to be any cost savings.’
But the analysis found promising results for the ‘hub and spoke model’ by groups of federated practices. It said the pilots showed this did ‘enable practices to deliver a wider range of services to patients over more hours of the week’.
It also said the Challenge Fund, later renamed the GP Access Fund, ‘provided a much welcomed injection of investment into the primary care sector’.
NHS England has said it will publish the evaluation of the second wave of pilots later this year.
The report also found:
- ‘On average, the annual cost per registered patient to support additional extended hours is £5.60. This represents a full cost covering all clinical staff time and overheads associated with setting up a new service; typically 50% of this cost can be attributed to GP time. The annual cost per hub serving 40,000 registered patients is therefore around £224,000.’
- ‘IT interoperability, information governance, securing indemnity insurance procurement and CQC registration have been the most commonly cited process barriers.’ These ‘challenges’ have ‘caused mobilisation delays and had cost implications’, with NHS England having tried to intervene to help Wave 2 pilots not face the same problems, said the report.
- ‘Capacity issues’ included ’difficulties in recruiting (especially ANPs) or competing with OOH providers for GP time’. The report said ’some pilots have relied on incentivising GPs… and this may not be sustainable in the long term’.
- ‘Telephone-based GP consultation models have proved most popular and successful’ out of alternative extensions to access piloted. But ‘other non-traditional modes of contact (for example video or e-consultations) have had fewer tangible benefits with issues around implementation’ (including low take up).
Source: Prime Minister’s Challenge Fund: Improving Access to General Practice, second evaluation report to September 2015, by SQW and Mott MacDonald