There is no escaping the issue of access to GP appointments.  Now more that ever it is sitting at the top of the national priority list, so what can we expect the future to look like?

There is seemingly a media campaign highlighting the challenge many patients face in obtaining a face to face appointment with their GP (e.g. here).  The highly public nature of this issue means that it is the government’s highest priority for general practice.

At the same time, the erroneous belief that the reason emergency departments are struggling is because patients cannot get to see their GP pervades Integrated Care System (ICS) thinking.  The priority for ICSs is now to ensure that ‘something is done’ about this issue.

This was the context that the Fuller Report was produced in.  Despite the framing of the report as “a vision for integrating primary care”, the framework for shared actions is clear that the number one priority 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 patients” p34.

I have written already about the single urgent care teams the Fuller Report proposes.  In this article I noted the lack of clarity in the report about exactly what was intended by the notion, and that much of what was written raised more questions than answers.  However, talking to different people it seems that there is a likely direction of travel.

PCNs are already putting plans together to outline a single model of delivering extended access across each PCN to start in October.  The requirement for on the day demand to be organised across the practices in a way that integrates all of the service offerings and guarantees same day care will be added on to PCNs.  The logical third part of the jigsaw will be to also give responsibility for out of hours care to the PCN.  Thus PCNs will have responsibility for 24 hour delivery of urgent primary care in their area.

PCNs meanwhile will most likely fall much more under the remit of ICSs.  Their rebranding as Integrated Neighbourhood Teams and shift of funding from the national contract to ICSs will mean that performance management will come locally.  Don’t expect this to be as light touch as we have seen in many areas over the delivery of the PCN DES specifications.

This of course has huge implications for practices.  While many areas are working on plans for extended access that minimise disruption for practices (either stick with the existing provider, or enable all or part of extended access to be delivered by practices where there is capacity/will to do so), the same approach is not going to work for in hours appointments where many practices are not able to offer same-day appointments.  GP capacity is insufficient and falling, so a different approach, one that most likely involves the patients of individual practices being seen either in PCN ‘hubs’ or by other practices, will be needed.

For some this will represent an unacceptable move away from the core model of general practice, where individual practices deliver cradle to grave care for their list of patients.  This new model creates limits on where continuity of care is required, and splits urgent access away from the traditional model.  For others it will be a welcome relief from the incessant demands placed on the practice, with no hope of them ever being met.

It seems we have a rocky road ahead.  Many PCNs have found getting to agreement across practices on extended access challenging enough, and the prospect of doing with the same with in-hours on the day demand and potentially even out of hours extremely daunting.  Meanwhile, this will feature highly on the priority list of the new ICSs, and given the wider system pressures it would not be surprising to see many adopt a relatively heavy handed approach.  At the same time there will undoubtedly be a backlash across many parts of general practice because of the challenge it poses to what represents core general practice.

Whatever your views, I think it would be sensible for practices to start thinking about this issue now, and working out how they want the future to unfold.  Getting on the front foot, rather than waiting for the system to impose something on you, seems the best strategy to take right now.