GP Extended Access - Equality Impact Assessment: August 2018 1. Introduction In April 2016 NHS England published the General Practice Forward View (GPFV) which set out a plan, backed by a multi-billion pound investment, to stabilise and transform general practice. The plan recognised the unprecedented pressures facing general practice and contained specific, practical and funded steps to grow and develop workforce, drive efficiencies in workload and relieve demand, modernise infrastructure and technology, and support local practices to redesign the way modern primary care is offered to patients (including through practices working together to provided extended access to patients). As part of the GP Forward View commitment and Refreshing NHS Plans for 2018/19, CCGs are required to commission additional primary care capacity for 100% of their population by 1st October 2018 to enable extended access to GP services, including sufficient routine and same day appointments at evenings and weekends to meet locally determined demand. This must include ensuring access is available during peak times of demand, including bank holidays and across Easter and New Year periods. 2. Details of Service Name of person Emma Joyeux completing EIA: Commissioning Lead - Primary Care Title of service GP Extended Access Who will be affected by this service? Patients GPs and general practice staff The provider will be expected to develop relationships and work in close partnership with other health and social care providers and stakeholders relevant to the patient pathway, including but not exclusive to: a) GP practices b) Urgent care centres c) Secondary care d) Community nursing teams e) North East Ambulance Service (NEAS) f) NHS Tees, Esk & Wear Valley (TEWV) Trust g) NHS 111 h) Single Point of Access (SPA) i) Local Authority services j) Local pharmacy k) Voluntary sector Page 1 of 6
What is your source of existing evidence General Practice Forward View (GPFV) Five Year Forward View (5YFV) Refreshing NHS Plans for 2018/19 Evidence What does it tell me? National reports and evidence The GPFV recognises that although public satisfaction with general practice remains high, patients are increasingly reporting difficulty in accessing services. In addition, it is acknowledged that many practices would like to offer better access, but are experiencing increasing pressure causing difficulties in offering their patients timely appointments, which is frustrating for practice staff and patients alike. Through the GPFV, NHS England therefore provided additional funding for CCGs to establish extended access to general practice services, with the following core criteria: Requirement Timing of appointments Details Commission weekday provision of access to pre-bookable and same day appointments to general practice services in evenings (after 6.30pm) to provide an additional 1.5 hours every evening Commission weekend provision of access to pre-bookable and same day appointments on both Saturdays and Sundays to meet local population needs Capacity Measurement Advertising and ease of access Provide robust evidence, based on utilisation rates, for the proposed disposition of services throughout the week. Commission a minimum additional 30 minutes consultation capacity per 1,000 population per week, rising to 45 minutes per 1000 population. Ensure usage of a nationally commissioned new tool to be developed during 2017/18* to automatically measure appointment activity by all participating practices, both inhours and in extended hours. This will enable improvements in matching capacity to times of great demand. (*Please note this is not currently available and no date has been provided by NHSE as to when this will be available for use) Ensure services are advertised to patients, including notification on practice websites, notices in local urgent care services and publicity into the community, so that it is clear to patients how they can access these appointments and associated service. Ensure ease of access for patients including: All practice receptionists able to direct patients to the service and offer appointments to extended hours service on the same basis as appointments to nonextended hours services Patients should be offered a choice of evening or weekend appointments on an equal footing to core hours appointments. Page 2 of 6
Digital Inequalities Effective access to wider whole system services Use of digital approaches to support new models of care in general practice. Issues of inequalities in patients experience of accessing general practice identified by local evidence and actions to resolve in place. Effective connection to other system services enabling patients to receive the right care the right professional including access from and to other primary care and general practice services such as urgent care. 3. Equality Impact Assessment Who is intended to benefit from the implementation of this piece of work? A GP Extended Access service is to be commissioned in both Darlington CCG and in Hartlepool and Stockton-on-Tees CCG. Darlington CCG covers one local authority serving a population of approximately 108,428 (as of July 2018). Hartlepool and Stockton-on-Tees CCG cover two local authorities serving a combined population of approximately 297,552 (as of July 2018). The GP Extended Access service aims to benefit every patient registered with a GP in the respective CCG boundary areas, including all patients with protected characteristics: Age Sex Disability Race Sexual Orientation Gender reassignment Religion or belief Pregnancy and maternity Marriage and civil partnership What are the key outcomes/benefits for the groups identified above? The CCG is commissioning a GP Extended Access service that supports its strategic commissioning intentions which are: Providing a cohesive, clinically-led commissioning system which delivers seamless, integrated out-of-hospital services based around the needs of our population A sustainable primary care fit for the 21st century, delivering appropriate access to high quality, cost-effective, patient-centred care, through a motivated, diverse and appropriately skilled workforce To secure maximum value for patients and service users whilst delivering high quality care by delivering an overall reduction in unexplained variation in care and improvement in efficiency GP Extended Access is aimed at providing additional clinical capacity in general practice, at a time when there is considerable pressure on healthcare services as a Page 3 of 6
result of rising patient demand. The commissioning of this service will enable: Patients to receive high quality, responsive and convenient care in a location closer to home Patients to have an increased choice of access An increase in capacity in primary care during early evening, weekends and public holidays Support towards the reduction in the number of contacts at acute secondary care and in urgent care services The service will deliver primary medical care services for patients who want to access services outside of core hours (as defined in the GMS, PMS and APMS contracts) and is in addition to any clinical sessions delivered outside core hours under the Extended Hours Directed Enhanced Service (DES). Does it meet any statutory requirements, outcomes or targets? To ensure care is delivered in the right place at the right time to deliver the best quality outcome, ensuring people recover from ill health or injury To ensure more people have a positive experience of care and support To support and encourage people and their carers to take control of their own health and make informed choices about where and when to access healthcare To simplify and ensure timely access to services To involve people in decisions about healthcare To promote self-care and awareness of signs and symptoms of ill health and to promote and support safe and independent living To appropriately manage and monitor our provider contracts, activity and demand; To encourage innovation and productivity in providers To ensure effective CCG governance processes and compliance with law and guidance To ensure the organisation promotes and makes incremental improvements in sustainability To make the best use of information management, technology and business intelligence To promote and adopt innovative ways of working to improve the experience of our population To develop workforce plans to support a sustainable health and social care system PROTECTED CHARACTERISTICS ANALYSIS OF IMPACT Age The GP Extended Access services are an extension of existing primary medical care services and are intended to benefit the registered population of Darlington, Hartlepool and Stockton-on-Tees. It is intended that access to primary medical care services outside of normal opening times is a positive consequence for patients who find it difficult, or are unable, to access primary medical care services during normal opening times. Sex Page 4 of 6
This service is available equally to men and women, and no negative impact is therefore anticipated. Disability Providers are required to meet the accessible information standard to ensure disabled patients have information in a format which is appropriate for their needs Premises where services are provided from will be DDA assessed to ensure all of the defined requirements are met No negative impact has been identified at this stage Race No negative impact is identified at this stage. The service has access to translation services for non-english speaking patients. Sexual orientation Although no specific issues have been identified within this scheme, the provider will be reminded of the requirement to adhere to equality legislation on sexual orientation. Gender reassignment There are no foreseen negative consequences for people accessing the service due to gender reassignment; however, it is recognised that inclusive policies, awareness and training are key for providers. Religion or belief There are no foreseen negative consequences for people accessing the service due to religion or belief. Pregnancy and maternity Although the service does not provide specific antenatal care; there are no foreseen Page 5 of 6
negative consequences for people accessing the services provided. Marriage and civil partnership There are no foreseen negative consequences for people accessing the services due to due to their marital or civil partnership status. Other identified groups Carers Carers generally experience poor physical and psychological health and poverty as many give up paid jobs to care for family members. It is intended that access to primary medical care services outside of normal opening times is a positive consequence for this group of patients. Page 6 of 6