The challenges and benefits

Improving access, capacity and management of urgent care in general practice

The Challenge for General Practice

Some practices have taken this work and have dramatically improved their management of same day and urgent care.  Many others have found that they need more support if they are to translate a better understanding of what they need to do into how they can take practical steps to make this happen.

Manually, developing a capacity plan is a time intensive activity, which tends to result in practices not undertaking the activity on a regular enough basis, if at all. 

Being online and, with an increasing number of practices taking part, practices will also be able to benchmark their own system and process against other local practices and those from further afield. 

The benefits for General Practice

There are substantial patient benefits and benefits to practices.  There are obvious safety benefits if patients can get through to the practice by phone quickly, if receptionists are alert and trained to spot the signs of urgency and if the practice is able to respond quickly as necessary.  We described in the report a number of examples including one where small and single-handed practices had jointly commissioned a home-visiting service that ensured that patients could be seen promptly when previously too many of these cases would have resulted in an emergency response.  Whilst the service provided obvious benefits that were appreciated by patients by allowing a clinician to see them promptly at home, the GPs involved in commissioning it also described how it had made their life easier and allowed them to give a much better service to the patients who came to their surgery.

Before, during and since working on the report we have seen and advised a considerable number of practices and we have identified some key gaps in the ability of practices to undertake the basic work that would be required to implement the recommendations in the report effectively.

The Potential Impact on the Wider NHS

There are potentially significant gains if practices in each area manage urgent care effectively as we have seen reductions in acute admissions in some cases that are estimated as between 20 and 40% as a result of good management of urgent care in general practice.  Although this benefit will not be achievable in every case the aim of the work is to fill the gap in capability of practices to undertake regular and ongoing capacity planning to ensure their response to urgent care is as effective as possible.  The number of appointments in general practice is so large (300 million each year across England) that minute changes in the access and responsiveness can have a dramatic impact on secondary care.  It is because of this gearing effect that good General Practices that provide an accessible service to their patients deliver great benefits to the local health economy. 

There are also wider benefits as other partners in the wider health community, including Hospital Trusts and Ambulance Services, understand that commissioners are developing more comprehensive strategies for managing urgent and emergency care.  The all consuming focus on the key national standards for urgent and emergency care diverted attention away from a whole system solution, but has now been relaxed by the new coalition government.  General Practice is the first place where most people go with an urgent problem and, as we have demonstrated above, improving care as early as possible in the patient pathway is likely to have a significant impact on the stem as a whole.