Organisation implements an extended hours primary care service to improve patient experience, resulting in 4587 patients accessing the triage service, and thereby saving GP appointments

* Please describe the challenges or problems your solution set out to solve.

GP Care Wakefield was setup to deliver CCG urgent-care priorities. An over-stretched urgent-care, coupled with an uncoordinated and inefficient Primary Care same-day extended care offer led to the development of a case for change to improve urgent-care access to primary care across Wakefield.

This would ensure that people get the right advice in the right place, first time. Providing highly responsive urgent and routine care services outside hospital, ensures people no longer chose to queue in A&E. The project worked with the all Wakefield Federations, practices, and partners to maximise opportunities for improving workforce efficiency from design to completion.

* Please describe the actions you took to achieve your result.

An external Project team was identified by the CCG to work across the local system to oversee the development and mobilisation of the service. The aim was to design “A collaborative model of Primary Care to deliver a consistent, streamlined offer of urgent care during evenings and weekends to meet the needs of the Wakefield population”.

The project built on the foundations of previous good practice within the District which included Trinity Care nurse-led telephone triage service and other Federation-based extended hours services. The project invested a significant amount of time engaging with Practices and their Patient representatives through Patient Participation Groups at both Practice and Network Levels, and two specific patient and public engagement workshops. Strong Partnership working and clinical leadership was evident across all aspects of the project.

GP Care Wakefield provides a range of Primary Care services from two sites. These are staffed by GPs, ANPs, Practice Nurses, HCAs and receptionists. Patients access the service through their own practice.

Same day care is accessed by telephone with calls answered in a Call and Booking Service (CABS) by triage nurse professionals. The service is open weekday evenings, and from 09:00-15:00hrs weekends and bank holidays. Patients speak to a clinical advisor in the triage CABS, they will assess the patient’s need over the telephone promoting, patient self-care, providing reassurance or signposting to other services. Where clinically appropriate, triage will book a same day appointment to see a GP or ANP in the service.

This supports patients to choose well, and promotes self-care. These appointments are therefore utilised appropriately saving time, effort and money. It is anticipated that as access to primary care improves, there will be a reduction in unnecessary A&E attendances. GP Care Wakefield also provides up to 50 hours per week of accessible routine primary care appointments bookable by patients directly through their own Practice.

These appointments are available up to 20:00hrs on a weekday evening and 09:00-13:00hrs at weekends. The service was developed, designed and implemented over an 8-month project period supported by £200,000 of funding from the CCG. The CCG also provided support in kind, through communications and public engagement staff to maximise efficiency and expertise.

Approximately £15,000 was also required for investment in one off set up costs. Significant amounts of non-funded time were invested in the success of the project from a range of sources including local GP Practices and service delivery partners.

* Please list the most significant results

• Since 05/09/17, 4587 patients have accessed the Triage service with:

o 52% receiving a same day GP or ANP appointment at GP Care Wakefield

o 13% receiving self-care advice

o The remainder will be signposted or booked into a more appropriate source of care

• All of this demand would have previously been met by GP appointments, therefore the service has improved the productivity of GP utilisation saving 1308 appointments

• 98% of Patients were either extremely likely or likely to recommend this service to friends or family

• 86% of patients described their experience of the Triage Service as excellent or good.

* Describe how your project has spread to other teams, departments or organisations

370,000 patients from all practices in the district can access the service. The ambition to deliver at scale was embedded from the start. The project completed in December with the production of a project and service evaluation (attached). The service is replicable in other areas, and addresses the driver for all CCGs to have an Extended hours service by the end of 2018/19. Our evaluation was produced to support other CCGs and Federations with delivery of GP extended access schemes. The service hosted visits, and is producing online videos to share learning and is participating in show & tell days.