The £50 million Prime Minister’s Challenge Fund was established in October 2013 to help improve access to general practice and increase innovation in primary care. Twenty pilot schemes started work in April 2014, and the first independent evaluation of their work has now been published.
· The pilots have given over 7 million patients access to a new or enhanced primary care services.
· During the week, outside core working hours, 4.9 million patients have had access to a new or enhanced GP appointment service, with approx. 400,000 appointments provided.
· Access to core hour appointments has also increased, with approx. 520,000 additional appointments made available within core hours across the pilot schemes.
· At weekends 5.4 million patients have had access to new or enhanced GP appointment services.
· As of May 2015, there had been a 15% reduction in minor self presentation at A&E in pilot scheme areas, compared with the same period in the previous year; representing 29,000 attendances.
· It was noted that the take up of Sunday booked appointments was low, and it was suggested that these might best be reserved for urgent care.
· Pilots that built on joint working with ANPs, pharmacists, the voluntary sector, care homes, physiotherapists and paramedics released local GP capacity and more appropriately matched the needs of patients with practitioners.
· Based on the evidence from the pilots the report recommends that 41-51 total extended hours per week are required per 100,000 registered population in order to meet the levels of demand experienced, of which 30-37 hours should be GP hours.
Notes of Caution
· The report stresses the need to tailor solutions to local demand and demography, in order to provide relevant services and value for money service for patients.
· The achievements that pilots have made have not been without challenges. Many of these challenges have been process related and have caused mobilisation delays and had cost implications. IT interoperability, information governance, securing indemnity insurance and CQC registration are the most commonly cited process barriers. Acknowledging these issues, NHS England has established support for wave two pilots to ease and expedite mobilisation of their programmes and minimise duplication of effort in resolving common problems.
· Wave one pilots did experience some capacity issues, which often manifested as difficulties in recruiting or competing with OOH providers for GP time. There also remains some concerns around the availability of ANPs in particular, which are likely to be exacerbated as more local health economies press ahead with seven day services and introduce skills mix.
Further funding of £100m for a second wave of schemes was announced in September last year. Thirty-seven schemes have been selected for 2015/16 involving over 1400 practices and 10.6m patients.