1. Access to GPs Changes in Primary Care – Improving Services Ian Stidston

2. National Targets Access to a GP within 48 hours Access to a health care professional within 24 hours

3. GP Infrastructure 41 Practices 33 Local Contracts 5 National Contracts 3 Primary Care Trust run 63% of practices are classified a `Single Handed practices 2063 is the current average list size across Southend

4. Before the New GP Contract In 2002-3 there were 3,699 compulsory allocations across Southend Patients were routinely reporting having to wait up to 10 days before an appointment with a GP Southend was one of the highest under doctored areas in England

5. October 2002 – Introduction of a Local Contract 33 Personal Medical Services (PMS) Additional Investment which allowed for: Increased number of GPs Increased number of Nurses Recruitment of European GPs

6. Advanced Access If you do what you have always done, you will get what you always get.

7. Advanced Access 2003 – Southend PCT engaged practices on`Advanced Access Collaborative Recording and analysing demand Make changes to appointment systems, mising book on day and advanced bookings Implement new ways of working (telephone conversation, nurse triage, text messaging) However, not all practices applied the methodology fully

8. April 2004 – A New GP Contract Establishment of Open or Closed Lists A Directed Enhanced Service to reward practices for meeting access targets Establishment of a set of measures that reward quality in primary care (QMAS)

9. Current Monitoring of Access Monthly telephone surveys (Primary Care Access Survey) Quality visits Contacts through PALS Monthly monitoring returns submitted to the PCT

10. Current Position Zero compulsory allocations Oct –Dec 2005 PALS helped arrange 20 GP appointments (reduction of 42% from first quarter) Feb 2006 – Practice evidenced that they are able to offer patients an appointment within government targets PCT investigates direct evidence of patients not being able to access a GP within access targets

11. Current Position Circumstances will arise where pressures occur in practice and the PCT will assist practices to resolve situations as far as practical

12. The Future A new Directed Enhanced Survey for Access (2006/7) is being introduced – Part one – Practice plan demonstrating how practice will achieve access and its agreement to participate in the Primary Care Access Survey (revised) One Third of Payment – Part two – Will be paid based on the results of a national patient experience survey Two Thirds of Payment

13. The Future Breakdown of Second Payment Two working days30% Advanced Booking30% Telephone Access30% Preferred GP10%

14. The Future PCT needs to continue to work to support and incentive existing practices patient access PCT needs to increase overall capacity to ensure increased access to primary care