PERFORMANCE: The provision of more than 50,000 extra GP appointments in Greater Manchester last year brought a 3 per cent reduction in accident and emergency activity, it was revealed today.
Following the work within four “demonstrator” sites, it has been confirmed that seven day access to GP appointments and other primary care services will be rolled out across the city by the end of 2015.
An evaluation report by the National Institute for Health Research has assessed the impact made by the project in central Manchester, Bury and Heywood and Middleton last year, and health chiefs deemed the results to be encouraging enough to roll out the work.
The results of the evaluation were mixed, but the report found there was a statistically significant reduction in A&E activity of 3 per cent within the project areas, including an 8 per cent drop in “minor attendances”. About 65 per cent of the extra GP appointments were taken up.
In central Manchester, the evaluation said the 2 per cent reductions in total A&E activity and cost were not significant, but highlighted a 14 per cent reduction in minor attendances, when compared across Greater Manchester in the post-intervention period.
There was not a statistically significant impact on either out of hours GP usage or walk in centre activity, which the report said was “surprising”.
From a total spend of £1.3m, which also covered extra “in hours” services, the A&E savings were estimated at about £425,000.
The data for Bury showed significant 4 per cent reduction in total A&E activity and costs, but an unsignificant 3 per cent reduction in minor attendances, which suggested only part of the reduction in attendances could be attributed to the extra GP appointments.
There was a far bigger impact on out of hours GP usage, which fell by 38 per cent, and walk in centre activity, which dropped 14 per cent.
From a total spend of £526,000, there was an estimated £43,000 saving in A&E, with “hypothetical” savings of £164,000 for the out of hours and walk in services.
Heywood, which had an investment of £393,000, did not record any significant impact on A&E usage, which reduced by 2 per cent. Nor was there a significant impact on costs, out of hours GP usage or walk in services.
Middleton, which had an investment of £282,000, recorded a significant 3 per cent reduction in A&E activity, but this was coupled with 5 per cent increase in A&E costs, and no significant impact on minor attendances. The report said the increase in costs was possibly due to the increased acuity of emergency patients.
Dr Ivan Benett, clincial director for Central Manchester Clinical Commissioning Group, said the overall results had matched expectations.
He added: “Getting an 8 per cent reduction in minor A&E activity is exceptionally good. Any future improvements will be a bit of a guestimate, but I’d be disappointed going forward if we can’t reduce overall activity by between 5 and 10 per cent.
“It’s not paying for itself at the moment, but it’s not about savings because this is the right thing to do anyway, with the possibility of it being self-funded.”
He said there is no savings target for the project, or date at which it would have to break even, and about 15 per cent of GPs in central Manchester had taken part ion the project, with the rest opting out so far.
He added: “There was a lot of scepticism at the start, but when you’re making big changes there are bound to be people opposing you. But the local medical committee can now see I think that by and large it’s possible to provide the service without great problems for in hours general practice.
This article was updated following the release of the evaluation report, and an HSJ interview with Dr Benett.
Evaluation report by the NIHR and information provided by Manchester commissioners
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