What NHS England isn’t telling you, and more indispensable insight for commissioners. This week by HSJ primary care and community services correspondent Rebecca Thomas.
Is general practice reforming as envisaged by the GP Forward View? NHS England let slip earlier this year that it was collecting data against this important question, monitoring progress in each clinical commissioning group area. Naturally that piqued my interest, and I’ve managed to get hold of the dataset.
Inevitably it focuses on a small number of issues; some will doubt whether these are the best indicators of change, or indeed the most important things - but this is what is being measured. These include, in particular: online consultations, the spread of primary care networks, and extended opening hours.
Pushing online consultations
The data – which was collected in April – reveals just one in ten GP practices currently offer online consultations to their patients.
This number is surprisingly low considering promises made in 2016 of a £45m fund to “stimulate the uptake of online consultations”.
The information says 478 out of 6,721 GP practices provide online consultations, and only a fifth of that £45m fund had at that point been received by CCGs.
Richard Vautrey, chair of the British Medical Association’s GP committee, suggests this highlights the “limited amount of funding” which has been made available to GP practices for online services.
The national focus on driving online GP services has intensified over the past year, and has not been uncontroversial – ahem, GP at Hand. That’s unlikely to abate given the new health and social care secretary’s well-advertised passion for new and disruptive technology.
According to NHS England’s data, CCGs forecasted in April 2018 that within two years there will be a much more impressive 4,508 GP practices offering online consultations.
The data notes that least 1,500 GP practices have “no current plans” to provide these services.
As Helen Stokes-Lampard, chair of the Royal College of General Practice, pointed out to me that – quite rightly – access to GP services, whether extended hours or online consultations, needs to be based on the specific needs of a community.
It all about the networks
Earlier this year the Integrator declared primary care networks were the new show in town, and NHS England’s GP Forward View monitoring backs this up in spades.
The data claims at least 5,387 practices are part of a primary care network. This brings NHS England fairly close to its declared finish line of having the whole county covered by the end of 2018-19.
Of course, the fact that CCGs have listed practices as part of a network does not tell us much about how the networks function.
The whole idea behind these is that they support the integration of community and primary care services over a manageable population size. This would enable GPs to manage a multi-disciplinary workforce across a specific population.
It will take more than just portioning off practices into groups covering 30-50,000 to make this happen.
The success of the primary care network will essentially not just lie in how widely the model spreads but in whether they are promoting a change in the model of care.
Eventually there will also need to be an analysis of the effectiveness of the GP network. The Integrator notes it has been a long while since NHS England’s national vanguard program ended – which featured a number of network-like approaches – and the final official evaluation has yet to be published.
Extending GP opening hours
The deadline for CCGs to commission extended GP opening hours for their entire population is fast approaching.
By October – ie next month - all CCGs are expected to ensure 100 per cent coverage of extended GP opening hours for their populations.
According to NHS England’s data, as of April 2018, only 125 CCGs were predicting would have 100 per cent coverage by the national deadline. Now of course predictions can be wrong, and we will see in October whether the remaining 70 declare they bucked up their ideas, and have made it after all.
What the data doesn’t tell us is how the extended opening hours are being provided or how much use they are getting. Are they generally provided through a few hubs scattered across the CCG’s area, for example? Or is every practice offering those extra hours. The latter is unlikely, whereas the first option is common but has its limitations.
When asked how many contracts they have in place for extended access hours, most CCGs said one. Could this mean that the extended GP access contracts, which can be considerable in value, are going to just one provider?
If they are, these are more likely to be large scale corporate outfits, rather than individual GP practices or GP federations.
Data supplied under the freedom of information act