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'Improved Access' to GPs: a new scheme to advance primary care - and introducing Wiltshire's GP Alliance

In the latest tweak to the NHS, the government has funded an 'Improved Access' scheme to provide more GP hours for Wiltshire patients.  This comes with new money, but no new staff.
The scheme has already been piloted in 57 areas.  The rollout to the rest of England - including Wiltshire - comes into force on Monday (October 1). 

It will mean people will be able to pre-book routine appointments to see a GP, practice nurse or other health professional based at Wiltshire GP practices in the evenings from 6.30pm to 8pm, and at weekends and Bank Holidays.  This is not a walk-in service - it only applies to booked appointments.

In total, an additional 235 hours per week of additional clinical time will be available to those in the county who are registered with a Wiltshire practice.

In Wiltshire this has been funded by £1,567,094 to be spread around the county's 48 practices in proportion to the size of their patient list.  This new money will be used by practices working collaboratively, sharing workforce and organisational expertise. It will also support innovative ways of working such as recruiting staff from outside traditional primary care roles, which till now may not have been feasible for individual GP practices.

The organisation of Improved Access has been co-ordinated by Wiltshire's fledgling GP Alliance [see separate story]with a team of six Wiltshire GPs and practice managers including Fovant GP Dr Lindsay Kinlin: “Whatever your local area of Wiltshire, appointments will be offered as usual during the week, but now you can also be seen at any participating surgery during the evening or weekend."

"People can book a weekend or evening appointment by contacting their usual surgery during normal opening times.  Your practice will explain the process, and ensure the booking is appropriate for your need." 

"We will also request your consent to allow us to share your medical records with the practice where your appointment is due to be." 

Dr Kinlin told marlborough.news that the new service will be of special benefit to people who find it difficult to attend GP appointments during the working day due to work or caring commitments. 

The rollout for Wiltshire has been on a tight schedule. It was supposed to happen in April 2019, but last April the government changed tack - wanting it in place by October to help with wider resilience plans for the coming winter months. 

Welcoming the plans at the Wiltshire Clinical Commissioning Group (CCG) Board meeting this week, one GP described the GP workforce as "...not broken but breaking".  It was stressed it will bring no improvement in workforce numbers. 

Not everyone is in favour of the Improved Access scheme.  Some GPs see it as changing their existing contract by stealth.   And doubts have been cast on the success and achievements of the pilot projects. 

In May it was reported that just one in five GP 'Improved Access' pilot schemes had hit NHS England’s target for extending GP opening hours.

Four of Wiltshire’s 48 practices - including KAMP (the Kennet & Avon Medical Partnership which runs Marlborough & Pewsey surgeries) - are not joining the scheme.

KAMP has told marlborough.news: "Since our merger last year, Kennet and Avon Medical Partnership has managed to recruit two new doctors, as well as several nurse practitioners in order to improve services to our patients. However, demand continues to rise and at times our patients have longer waits for appointments than we would like."

 "Whilst we welcome the investment in primary care that Improved Access could bring, we are not able to provide what is demanded for this additional service without more staff, or without compromising the care we give to our patients in core hours. To provide more hours in the evening or at weekends would mean removing staff from our core hours."

 "We appreciate the work that the CCG and the GP Alliance has done in order to offer Improved Access appointments across Wiltshire. There is a requirement for Improved Access to be provided across groups of practices, rather by an individual practice."

"We believe this reduces continuity and consequently our ability to care for those who need us most, such as those with long term conditions, those with mental health problems, and families with young children, to name but a few."

"For those patients who value convenience over continuity this will be a useful addition, and we are assured by the CCG that our patients will be able to access these.  We will continue to offer extended hours appointments across both sites with early morning and evening availability."

 "Simply put, we feel it would be disingenuous of us to reduce the appointments we currently offer to our registered population in order to support Improved Access."

The Improved Access programme for patients in our area will be led by Ramsbury Surgery (working in collaboration with Lambourn Surgery and Old School House Surgery in Great Bedwyn.) 

A spokesperson for Ramsbury Surgery told marlborough.news how grateful they are to their management team and surrounding practices for their hard work and cooperation in setting up Improved Access on a very tight timescale:  "We felt strongly that this service should be provided by local Primary Care Practitioners rather than allowing the service to go to a private provider at a far distant site that would not be of any benefit to our patients."

"The service will improve access for patients and will be reviewed on a regular basis." 

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