8-8: An Update Dr Craig Seymour GP & Darzi Fellow April 2015 Dr Craig Seymour GP & Darzi Fellow Craig.Seymour@camdenccg.nhs.uk

Background Ongoing national political debate about GP opening hours and access 8-8 7 days a week working part of NHSE London Region’s Access Standards Model is of some routine care (pre-booked), the rest urgent care (same day) Built into Camden’s Primary Care Mandate Shared Saturday morning routine clinics already happening in Haringey Islington recently granted £2.5m for similar hub-based model It is a hot topic, built in by NHS England and also locally. There is some precedent, although much is new. Haringey are operating hub Saturday morning clinics of pre-booked appointments for patients of local practices Islington have been awarded the Prime Minister’s Challenge Fund to form hub based clinics over the next year In camden this is new Hence we will be taking it in chunks, starting with offering routine pre-bookable appointments on a Saturday

Phase 1 8-8 Phased approach – start with a small chunk

Phase 1: What it is… Additional appointments for Camden GP registered patients at new times Saturdays 9am to 5pm Proposed each hub 2 GPs and 1 nurse Routine care, pre-bookable by own GP practice only Hub-based convenient locations Each serving minimum population of 50,000 Provided by clinicians with awareness of local needs, services and policies A high quality service 3515 appointments extra per year in phase 1b No reduction in core services

Phase 1: Why? Children and working age adults find current access and routine opening times difficult high users of A&E Improve continuity hypothesis: Shifting some routine care for whom continuity isn’t a priority should create capacity within hours for whom it is Electronic records means every contact counts 1) Based on Local D-Day audit and out of hours data – this is despite offering more than the RCGP recommended number of appointments 2) Additional capacity over 3 hubs = 3,575 appointments per year 3) Electronic records providing seamless care, note keeping and making each contact count. Data if seen in out of hours is not coded and can get lost 4) Should move some demand for appointments for people for whom seeing a doctor is more important than seeing a particular doctor. This should allow those who have more complex care needs for whom continuity of care is more important to do so during core hours

Phase 1: How it would work Own GP practice books appointment electronically Patient seen at hub clinic by local GP/nurse – full access to records, tests and referrals Own practice notified that patient seen, and any follow up required All results and correspondence to own practice Notes automatically updated in real-time Clinical quality standards and governance rules apply Patient feedback is collected after each encounter for analysis and to adapt and refine service This is the flow diagram Key is that it is a quality service Will likely not offer extended services from the outset, such as phlebotomy, tissue viability

Phase 1: What it is not… Every practice open 8-8 7 days a week Your own doctor working 8-8 7 days a week Change or reduction in existing services offered by your practice A walk-in or same-day service Another additional and confusing access point An anonymous doctor who doesn’t seem to know anything about your health or recent care

Working with the people of Camden to achieve the best health for all Approached in bite size chunks Allows learning about needs, population, feedback, services required before larger scale roll out Also info re quality, safety and IT. New situation of GPs working together, and the CCG working with groups of GPs Key is ongoing real time patient and system feedback & evaluation Phase 1b will be taking the learning from 1a and applying it at other locations to give 100% Camden population coverage Working with the people of Camden to achieve the best health for all

Your clinical data Like seeing a locum Only with your consent Restricted dependent on role

Working with the people of Camden to achieve the best health for all Why Phased approach? Generate evidence and data Ensure safety and quality Pilot before roll out Ease into working together Practices Patients Commissioners Phase 2 involving urgent care Working with the people of Camden to achieve the best health for all

Next steps Patient group engagement Support of GPs and practices Procurement advice Premises IT and Quality Assurance Internal CCG processes: business case development, costings, sign off Design of service specification Further working through of Phase 2 PG involvement including Healthwatch

Craig.Seymour@camdenccg.nhs.uk Dr Craig Seymour GP and Darzi Fellow Camden CCG