This is a draft document which is currently being reviewed and is therefore subject to change. DRAFT- 2018/19 London Extended Access Guidance and Specification 1. Background The NHS England mandate sets out a requirement to ensure that everyone has easier and more convenient access to GP services, including appointments at evening and weekends. All London CCG s have successfully established extended access services which allow for 8-8 day a week GP services for their local populations. London has achieved this ahead of the rest of the rest of the country and is in a good position to move forward in the continued delivery of a joined up service which provides choice, additional capacity to the system, supports improved access and outcomes for its population. Healthy London Partnership is working with stakeholders to support the strengthening of collaboration to drive up quality and reduce inequalities in general practice provision for all London patients and anticipate plans for extended access delivery in the capital support this ambition. Core requirements in regard to the extended access service have been agreed at a national level and relate to; Timing of appointments Ensuring a full 8-8 7 day a week service with same day and pre bookable appointments, which are delivered in locations and at levels that are evidence based and meet local need. Capacity - Commissioning an appropriate level of service to meet local need. Measurement Using the nationally commissioned tool to measure capacity in practice and in hubs to support matching capacity to demand. Advertising and Ease of Access Ensuring effective communications to patients as to how services can be accessed and supporting ease of access through training and awareness of staff who are directing and booking patients into the service. Digital use of digital approaches to support new models of care. Inequalities - Issues of inequalities in patients experience of accessing general practice identified by local evidence and actions to resolve in place. Effective access to the wider whole system - Effective connection to other system services enabling patients to receive the right care with the right professional including access from and to other primary care and general practice services such as urgent care. The above areas must be embedding into Extended Access Service delivery and will continue to be used as measures for STP s and CCG delivery.
The 2018/19 London GP Extended Access Funds allocation for Extended Access service delivery is XXXX with specific details of STP allocations to be provided separately. The provision of previous Extended Access funding has been given with a requirement to meet London standards. This document set out the core requirements which organisations must adhere to as part of their funding and delivery of extended access services for 2018/19. Failure to meet the standards set out below will result in the review and/or withdrawal of funding allocations. 2. Extended Access service requirements The following criteria are essential to the offer and delivery of the service and commissioners will be expected to evidence this. 2.1 Timing of appointments and appointment provision Coverage of a full 8-8 7 day a week GP primary care service must be in place this as a minimum allows for a service that is open weekday evenings 18:30 to 20:00 and 08:00-20:00 on weekends. This includes 08:00-20:00 bank holiday provision with the expectation that the service is a 365 day a year service. Appointments must be available each day for both in advance and same day booking. Appointments in the extended access service must be directly bookable via; All local GP practices; 111 Provider(S) Service must be prioritises on the DOS; Local Urgent and Emergency Care provider(s) The service should actively support the redirection of service users from e.g. A&E, 111, GP practices through offering patient convenience and appropriate levels of appointments, working with other providers and basing this on evidence based local need. Providers of extended access services must have full access to patient medical records including read and write access. Face to face appointments must be provided a part of service delivery. The service can also deliver appointments via a range of routes that are appropriate such as telephone or video consultation. All appointments must be provided with clinicians and GP provision should always be included in the daily core offer. However, consideration and inclusion of nurses, pharmacists and other health professional services are encouraged. Commissioners must ensure effective service pathways are in place, which contributes to ease of access for patients and supports the wider health system with a particular focus on GP and urgent and unscheduled care pathways. 2.2 Capacity and provision The level of appointment provision and type, length of appointment provided must be evidence based and sufficient to support local access requirements. The expectation would be to provide 30 mins per 1000 registered population with a minimum of 20
minutes per 1000 registered population appointments needing to be provided. The level of appointment provision per thousand population can be ascertained by calculating the number of minutes of extended access provision and dividing this by the registered population/divided by 1000. Commissioners can put forward cases as to why less or more appointment provision is needed including within core GP access hours (08:00-18:30). Commissioners would be expected to obtain approval from Healthy London Partnership/NHS England London Region for provision that varied from this guidance with clear reasons for how this will best meet patient need. Any changes to agreed level of service provision must also be communicated and agreed. Consideration of numbers and location of extended access hubs should have taken place to meet local need, allow for ease of equitable access including consideration of the potential to co-locate with other services such Urgent Treatment Centres. The service must have built in provision for any bank holiday and contingency plans for surge period requirements (e.g. industrial action or pandemics) so that the service can support wider system demand. The service must be additional service provision and capacity to the Extended Access DES and any Local access commissioning such as Local Improvement Services, WIC or urgent care capacity. The extended access capacity provision and urgent care capacity should be in line with the 2017 Urgent Treatment Centre standards and requirements. (https://www.england.nhs.uk/publication/urgenttreatment-centres-principles-and-standards/) 2.3 Measurement Commissioners and providers must utilise national workload tools at GP practice and hub level to support management of capacity ( when available) A system should be in place which allows for the monitoring of provision and utilisation of appointments and which supports the management of DNA s. The expectation is that service utilisation should be at 90% as a minimum. Patient satisfaction and user profile data information must be collected and utilised to understand and improve services as needed and patient engagement should be built into service review and development. 2.4 Advertising and Ease of Access The service should be accessible to the entirety of the CCG population. The services must cover the needs of non-registered populations and have a clear policy to actively support registration with local GP practices. That additional GP capacity is available 8-8 7 days a week must be advertised in all local GP Practices including GP practice, CCG and NHS choices websites Commissioners must demonstrate that all GP practices are aware of, promoting and referring into the service. This additional, local and flexible GP capacity should be advertised in urgent care centres and other community venues. Commissioners may benefit from any London/National communication campaign but are expected to use extended access funding to continue to support on-going locally focused communication campaigns.
2.5 Digital Access to and sharing of electronic patient records are a core requirement of the service supported by interoperable digital solutions which supports information sharing and care delivery across organisational boundaries. The extended access services digital systems should be integrated into local digital service pathways including but not limited to functionalities being available for direct booking through GP practices, patient online booking (when available), 111 or other online services such as NHS online. Commissioners should maximise and align to emerging digital technologies and wider NHSE digital agenda to support easier access to services such as Apps, wearabales, use of e consultation systems and online consultations. This should not limit access to services for those without access to digital technologies butt should be provided alongside a range of access options which support improved access. Extended Access Service locations must have the appropriate infrastructure to support digital ways of working including n3 connectivity, WIFI and next generation technology as needed. Practice websites should be considered a key point of access which should support right access for patients with the principles of right place, right time, right person, and right care. The extended access service should be built into this pathway and promoted as an access point to support right access for patients. All appropriate information governance requirements should be considered and met in implementing digital solutions and data sharing arrangements. 2.6 Inequalities An equalities assessment must have taken place which is linked to broader primary care and other inequalities and any associated action must be addressed. The provision of the additional GP capacity should ensure this does not disadvantage any one patient group, but act as an enabler for improved general practice access with patients being seen in the most appropriate setting for their needs. Commissioners may want to review the following national inequalities document to support this work https://www.england.nhs.uk/publication/improving-access-for-all-reducing-inequalities-inaccess-to-general-practice-services/ 2.7 Effective access to the wider whole system In order to support effective access delivery of care, the extended access service pathway must be integrated with local systems including alignment with self-care, GP services, 111, out of hours and local urgent and emergency care services and pathways. This can include but is not limited to direct booking functionalities being in place to support referral and redirection into access services at appropriate points in the system e.g 111, unscheduled and emergency care services. Commissioners should ensure that the service effectively integrates with local core GP services and pathways to support practices in providing additional capacity and patients in the provision of a seamless primary care service.
Commissioners must ensure that the access hub information including numbers, locations and opening times are profiled accurate on all directories of services. The 111 Directory of Service should prioritise extended access services over other primary care services and work must be undertaken with 111 providers to ensure effective integration of the hub service with 111 service delivery. The service should be able to refer to necessary diagnostics to support patient care and refer into community, acute and other services as per local pathways and agreement. Robust clinical governance policies should be in place to ensure any investigations are acted upon, and referrals and investigations clearly integrated into the patients care through their registered GP practice. All handovers of patient care and patient information that occur as part of an integrated extended access service pathway must follow the appropriate, best practice and legally required governance to support patient safety and care (To be expanded) 2.8 Additional Commissioner Requirements Appropriate contractual arrangements must be in place and procurement processes followed which meet relevant legal requirements must be followed in the commissioning of the service. All extended access funding which is allocated to the provision of the 8-8 7 day a week service should be used for improving access as per the details in this document. Commissioners must ensure in providing the service that all legal, regulatory, safety and governance requirements are in place. Commissioners should consider the outcomes and impact and of service and ensure measures are in place to understand and respond to this within the contract they hold with providers. This would include the collation of patient satisfaction data, minimum data sets and audits of services.more info to be added. The service should support the needs of other local and national strategies and models of care. 3. Assurance and Data requirements 3.1 Commissioners will be expected to share data with Healthy London Partnership/ London Region which supports the understanding of service delivery. Monthly Access Dashboard information which includes but is not limited to details of services in place, appointment offer, utilisation, DNA s, spend, communication activities Details of patient pathways through the service. Patient experience, MDS and audit data for service delivery on a (X..) basis Additional data which supports any local and national assurance and reporting requirements. Any information which supports the sharing of good practice and learning from delivering services.