There is much that is worthy of further discussion in the Fuller report.  Last week I considered integrated neighbourhood teams, and this week I take a deeper look into the idea the report introduces of single urgent care teams.

There is a context for this notion, which is the Our Plan for Improving Access for Patients and Supporting General Practice paper published last October.  That particular paper incurred the wrath of general practice, and the Fuller Report does seem to be trying to tread a difficult line between a national desire for the GP access ‘issue’ to be resolved, whilst avoiding letting it dominate the whole report.

Hence, while the paper introduces the idea of single urgent care teams in the middle of the document, it is telling that the number one action emerging from the report is to, “develop a single system-wide approach to managing integrated urgent care to guarantee same-day care for patients and a more sustainable model for practices.  This should be for all patients clinically assessed as requiring urgent care, where continuity from the same team is not a priority” p34.

It is also hard not to believe that implicit behind this idea is the erroneous belief seemingly shared by much of the system that lack of access to urgent care in the community (i.e. GP access) is the primary cause of the problems experienced in A&E and the wider urgent care system.  The report actually says that this change, “can also help to reduce demand on other urgent care services across the NHS iv”, although the reference it uses is of a video of how a practice has this system in place without any reference to the knock on consequences for the rest of the system.

This will inevitably lead to this particular action taking a high priority in the majority of Integrated Care Systems.  But what is the action?  The report states that it is for, “primary care in every neighbourhood to create single urgent care teams and to offer their patients the care appropriate to them” (p11).  “Same-day access for urgent care would involve care from the most clinically appropriate local service and professional and the most appropriate modality, whether a remote consultation or face to face” (p34).

It involves taking, “general practice in-hours and extended hours, urgent treatment centres, out-of-hours, urgent community response services, home visiting, community pharmacy, 111 call handling, 111 clinical assessment – and organise them as a single integrated urgent care pathway in the community” (p11/12).

But despite my best efforts, I am still not 100% sure what this means.  Maybe the idea of the paper is to build scope for local interpretation rather than dictate a one size fits all model, and this is why it feels difficult to nail down the exact intent of what is written.  Is it saying that all the on the day demand needs to be managed by a single team, and so that will include the team currently managing this within each practice?  Or is it saying that each practice will be a virtual part of a wider community team, operating with a single triage and capacity management system?  Or is it saying something else?

Either way, the implication is that each practice will no longer be managing its on the day demand separately from other practices.  If the model is going to “guarantee same day access”, what if a practice cannot offer same day GP slots to its patients?  Are those patients going to be seen by a GP at another practice?  The implications of a single team across a neighbourhood for managing all of this demand are enormous, and the only examples given in the report operate at a single practice level.

The model is also seemingly based on patients who ask for a face to face GP appointment being redirected to either a virtual appointment or an appointment with an alternative practitioner (and now add in alternative provider), something that practices have been articulating with little support for a number of years.  Meanwhile both NHS England and the government have been insisting in the national media that anyone who wants a face to face GP appointment can have one (regardless of need).  However, no action on a national communications about-face appears within the paper.

The vagueness around this idea is both an opportunity and a risk for general practice.  It is an opportunity because if this is really to be a system where solutions are generated locally as opposed to imposed nationally general practice can create its own interpretation of what it means, turn it into something useful, and then use the authority of the report to access system funding to support its implementation.  It is a risk because others may start to impose their interpretation of what it means on practices in an area, citing the report as their authority for action.

It highlights once again the need for general practice to organise itself locally so that it can positively influence how things develop.  A united local general practice can work together to make the most of the opportunity, but where no such unity exists the risk will almost certainly prevail.