1. 8-8: An Update Dr Craig Seymour GP & Darzi Fellow
April 2015
Dr Craig Seymour
GP & Darzi Fellow

2. 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

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

4. 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

5. 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

6. 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

7. Phase 1: What it is not… Every practice open 8-8 7 days a week
Your own doctor working 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

8. 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

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

10. 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

11. 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

12.
Dr Craig Seymour
GP and Darzi Fellow
Camden CCG