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Wednesday 26 June 2019
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How extended hours access helped us prevent 4,776 A&E and MIU attendances

Former practice manager Clive Cropper tells Management in Practice how extended hours access helped a group of Staffordshire practices dramatically reduce unnecessary attendances at the local minor injuries unit
 
Offering an extended hours access (EHA) service has been mandatory in primary care since October 2018.
 
But many schemes were helped off the ground years before that, with funding from former Prime Minister David Cameron’s Challenge Fund – a pot of cash initially announced in 2013 and specifically allocated to improving access to general practice.
 
One area to benefit from the second wave of this funding was Cannock Chase in Staffordshire, which launched its extended hours service on 1 September 2015.
 
The service was set up by Cannock Practices Network, an informal partnership of 12 practices, operating within a GP federation.
 
It served only these practices for three years, before being extended to two other networks: Rugeley, covering the north-east of Cannock Chase, and Villages  – which covers small towns and villages in south Staffordshire.
 
‘Inappropriate’ minor injuries attendances 
 
Clive Cropper is now retired but previously practice manager at Moss Street Surgery – one of the 12 initial practices.
 
He was also project lead for extended hours and says the service sought to address some patient access issues that had been highlighted in the CCG’s primary care strategy. These included ‘inappropriate’ attendances at the local minor injuries unit (MIU).
 
‘In a public consultation, the CCG asked patients why they were attending the unit rather than their GP surgery and a lot of people said it was because they couldn’t get an appointment with their GP,’ he explains.
 
‘So a lot of patients were basically “misusing” the MIU facility, if you like, for problems that really should have been treated within general practice and we wanted to try and address that.’
 
Mr Cropper adds that the practices also wanted to create an environment where they were working more closely together, because ‘while everybody was friendly, it was previously disparate’.
 
‘We got wind of the wave two funding for extended access and we thought that could help us tick some of those boxes, so we put in a bid for £321,000,’ he says.
 
The funding was confirmed in March 2015. However, due to the general election that year and the purdah restrictions this brought with it, the practices were not able to announce the successful bid or start work on the service until May.
 
This, Mr Cropper explains, eventually pushed back its launch to the September of that year.
 
‘Getting the practices to work more closely together’
 
The Challenge Fund money was used to create an extended hours hub within the Network Surgery. Operating from Cannock Hospital the practice had, Mr Cropper says, some ‘spare rooms’ that could be adapted.
 
‘We started off with 10 of our 12 practices coming on board straight away. Two of them didn’t at first because they weren’t on the same clinical system, EMIS Web, at the time.’ 
 
This system enables practices to access and share patient information with each other and it was, Mr Cropper adds, necessary for all practices to be on it to provide a service like extended hours access.
 
The remaining two practices joined in 2016, bringing the number of patients supported to 62,500.
 
The service has always been staffed by existing doctors, nurse practitioners and receptionists from the particpating practices - and they’ve never had to look for locum staff, says Mr Cropper. 
 
‘They were all willing helpers – we didn’t force anybody to work there, we just said that if anybody was interested in and had time to do some sessions, they should let us know.
 
‘It was a perfect demonstration of getting the practices to work more closely together – everybody really chipped in with either a doctor, nurse or receptionist from their own practice.’
 
‘Huge amount of support from patients’ 
 
At the time the service launched, there was no guarantee the funding would continue, Mr Cropper says. So the practices wanted to give themselves ‘the best chance they possibly could’ to show it would have benefits and impact positively on attendances at the MIU and A&E.
 
A patient satisfaction survey was set up to collect feedback during the first six months, the results revealing a ‘huge amount of support from patients’ for the service, he adds.
 
‘We had that argument ready if we needed it, but the funding came through from NHS England in the end. They kept it going and obviously rolled it out across the country last year.’
 
At the end of September 2018, the ‘powers that be’ decided that larger, more formal organisations had to be the ones to put in bids for the new extended hours contract – as of that October. This, Mr Cropper says, meant the Cannock Practices Network was no longer in a position to continue providing it.
 
Cannock Chase Clinical Alliance, a formal GP federation, was set up instead and this now delivers the service to all three localities, encompassing 23 practices and approximately 130,000 patients.
 
‘The positive impact was joyful’ 
 
An evaluation report written by Mr Cropper shows the service had a significant impact in its first three years in operation – with over 26,500 available appointments, of which 23,150 were booked.
 
A survey of almost 5,000 patients found that 98% wanted the service to continue, 99% were happy with the arrangements for making appointments and 94% were satisfied with their appointment time. 
 
Almost a quarter (22%) of ETA patients who completed a patient satisfaction survey indicated that they would have attended either A&E or the MIU had they not been offered an appointment at the hub. 
 
The report states that ‘extrapolating this over the three years and patient attendances’ suggests that the extended hours service prevented 4,776 attendances at A&E and the MIU. 
 
‘We had no real problems at all from a clinical point of view,’ Mr Cropper says. ‘It worked really well and it made everybody’s life easier. Particularly the patients’, but also for the staff.’ 
 
He has since gone on to support other areas with extended hours and present the service at national conferences, something he says has been easy to do because it’s not as if he’s ‘selling a dodgy secondhand car’.
 
He adds that he knows it was a good product that benefited patients and practices alike. 
 
‘I’m very proud of it – it was a great service to be involved in and the all-round positive impact was joyful. Having been in the NHS for 40 years, it was a good one to bow out with.’

 
 
 
 


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