General Practice Extended Access Survey - September London Results Briefing

Transcription

1 General Practice Extended Access Survey - September 2017 London Results Briefing Date: 1st November 2017 Author: Sultana Rahman, Healthy London Partnership, Transforming Primary Care s.rahman5@nhs.net 1. Background The extended access to general practice collection was launched in October 2016 with the aim to monitor the availability of pre-bookable appointments in general practice at evenings and weekends. The completion of this survey is a contractual requirement on general practices and it is submitted via the primary care web tool. The first collection took place during October 2016 and collections will continue bi-annually until March 2021 (See Appendix A for full timetable of data collection). The survey asks GP practices to complete a set of questions relating to their individual practice level extended access provision and a set of questions regarding group provision of extended access services. The combined response information is then collated via the national team and GP practices are either classed as reporting full provision, partial provision or no provision (See Appendix A for full list of survey questions and definition of classifications). Based on the current 100% provision of 7 day a week, 8-8 extended access services across London, the expectation would be that the achievement for London in this survey would be 100% for full provision. The March 2017 results for London showed that 49.3% of practices were reporting full provision for extended access which did not align with the much higher level of service provision in place at the time. This raised concern both at a national and London level in regard to how aware GP practices were of extended access services in their local area and in turn whether patients were being made aware and referred into these services. The results of the extended access practice survey also contribute to one of a range of indicators on the new STP assessment framework and concern was raised that this indicator did not fully reflect the services that were in place in each area. Following the release of the results of the March 2017 survey, work was undertaken in London to drive up awareness and accurate completion of the survey. The September 2017 survey results were published on the 31 st October 2017, with practices in London now reporting 69.7% full provision. Although this is a 20 percent increase from the previous survey results, it still does not reflect current 1

2 provision in London. There is also a high level of variation in results at CCG and STP level which requires further investigation and action. This briefing and the additional analysis (Appendix B) aims to; - Improve the understanding of the GP Extended Access Survey; - Set out the action taken in the London region since the publication of the March 2017 survey results; - Provide analysis of the September 2017 results; - Set out actions to be taken to improve upon the current achievement levels. 2. Work undertaken following the publication of the March 2017 results The following is a list of key areas of focus and action that took place. London Access Delivery Group - Ongoing discussion of results and how to improve upon achievement levels. A communication for issue to all GP practices in London was developed by the Healthy London Partnership (HLP) Primary Care team working with NHSE Heads of Primary Care and STP primary care. The communication explained the importance of the survey and highlighted that 8-8, 7 day a week extended access services were in place in their area - with the exception of City and Hackney whose service was not live at the time that the survey was being collated. This information was sent to practices a week before the month long survey collation period started and follow up messages were sent during this period. STP and CCG were asked to build on the communication at CCG level and tailor the message for local requirements. Individual discussions between HLP lead and CCG who requested data or assistance with this work took place. NHSE London Heads of Primary Care (HOPC) and teams undertook support work including contacting GP practices in person in some areas to ensure a full response rate. HLP lead liaised with the national team as to progress on response rates for London and supported additional dissemination of this information with the help of NHSE Heads of Primary Care. NHSE Heads of Primary Care supported a data cleansing exercise to remove a high number of practices which were closed and appeared in official information which would impact data quality. 3. Breakdown of the September 2017 results Appendix B provides a breakdown and analysis of the London results. Information is presented at a CCG, STP and national level. It should be noted that the expectation would be that all CCG s are at 100% provision and a RAG rating is only in use as guide to support an understanding of where potential issues and areas of focus should be. The RAG rating has been applied to the full provision data, with 80% (Green) set as a higher achievement level and below 60% (red) as a level of higher concern. At the point of collation of the survey, all CCG s with the exception of City and Hackney had 8-8, 7 day a week GP extended access services in place. The following are key points to note from the September 2017 data. London practices are reporting 68.4% (825) full provision, 28.6% (345) are reporting partial provision and 3% (36) reporting no provision. (See table A) 2

3 There has been a 20 percent increase across London on the reporting of full provision compared to March There is no CCG in London who is reporting 100% full provision. There is a high level of variation in the results with the highest achievement for full provision in Greenwich CCG (93.5%) and the lowest achievement in Harrow CCG (0%). 7 CCGs are reporting as being 60% and below for full provision 13 CCGs are reporting as being 80% and over for full provision 32 practices (excluding City and Hackney CCG practices) are reported no provision; CCG s that these practices fall under include Haringey, Brent, Hammersmith& Fulham, Sutton, Ealing, Redbridge, Tower Hamlets, Havering, Enfield, Hillingdon, Croydon and Harrow. 312 practices (excluding City and Hackney CCG practices) are reporting partial provision There are some areas which have shown marked improvement in full provision since the March 2017 results such as Hounslow CCG who have moved from a reporting of 12% to 79.1% in September 2017 and Barnet CCG who have increased levels from a 40.7% achievement to 93.2% in September practices across London did not respond to the survey. STP achievements for full provision varies with South East London at 85%, NCL at 82%, NWL at 64%, NEL at 69% and SWL at 53% ( See Table B). London results for the survey are higher than other regions with Midlands and East at 19.3%, North of England 34.2% and South of England at 19.2% for Full provision. However, the London level of extended access provision is much higher and no other region has full coverage. Table A CCG level response for submitted GP practice responses % % Submitted GP Practice response CCG STP Area Full Partial None No response NHS Greenwich CCG SEL 93.5% 6.5% 0.0% 11.4% NHS Barnet CCG NCL 93.2% 6.8% 0.0% 4.8% NHS Lambeth CCG SEL 93.2% 6.8% 0.0% 0.0% NHS Haringey CCG NCL 90.6% 6.3% 3.1% 13.5% NHS Islington CCG NCL 90.3% 6.5% 3.2% 6.1% NHS Richmond CCG SWL 89.3% 10.7% 0.0% 0.0% NHS Brent CCG NWL 86.0% 10.0% 4.0% 19.4% NHS Waltham Forest CCG NEL 85.7% 14.3% 0.0% 0.0% NHS Bromley CCG SEL 85.4% 7.3% 7.3% 8.9% NHS Hammersmith and Fulham CCG NWL 84.6% 11.5% 3.8% 13.3% NHS Southwark CCG SEL 83.8% 16.2% 0.0% 9.8% NHS Sutton CCG SWL 83.3% 12.5% 4.2% 4.0% NHS Bexley CCG SEL 81.5% 18.5% 0.0% 0.0% NHS Hounslow CCG NWL 79.1% 20.9% 0.0% 14.0% NHS Camden CCG NCL 77.4% 22.6% 0.0% 8.8% NHS Lewisham CCG SEL 73.7% 26.3% 0.0% 2.6% NHS Central London (Westminster) CCG NWL 73.3% 23.3% 3.3% 11.8% NHS Ealing CCG NWL 72.3% 24.6% 3.1% 15.6% NHS Redbridge CCG NEL 72.1% 20.9% 7.0% 4.4% NHS West London CCG NWL 71.4% 28.6% 0.0% 20.5% NHS Barking and Dagenham CCG NEL 67.6% 32.4% 0.0% 2.6% NHS Tower Hamlets CCG NEL 64.7% 26.5% 8.8% 5.6% NHS Havering CCG NEL 64.3% 26.2% 9.5% 4.5% NHS Newham CCG NEL 63.8% 36.2% 0.0% 11.3% NHS Enfield CCG NCL 60.0% 35.6% 4.4% 6.3% NHS Wandsworth CCG SWL 59.0% 41.0% 0.0% 0.0% NHS Kingston CCG SWL 47.6% 52.4% 0.0% 0.0% NHS Hillingdon CCG NWL 47.2% 41.7% 11.1% 21.7% NHS Merton CCG SWL 36.4% 63.6% 0.0% 4.3% NHS City and Hackney CCG NEL 11.9% 78.6% 9.5% 2.3% NHS Croydon CCG SWL 7.0% 89.5% 3.5% 0.0% NHS Harrow CCG NWL 0.0% 92.6% 7.4% 20.6% London 68.4% 28.6% 3.0% 8.4% 3

4 Table B STP level response for GP practice response % GP Practice Response STP Full Partial None No Data SEL 85.0% 13.6% 1.2% 5.4% NCL 82.3% 15.5% 2.2% 7.9% NEL 69.7% 26.1% 4.2% 4.7% NWL 64.0% 31.7% 4.1% 17.1% SWL 53.77% 45.0% 1.3% 1.4% Nb North East figures excludes City and Hackney results 4. Actions to be taken to support achievement of 100% result in March 2018 survey Although there has been improvement, the level of achievement in the September 2017 survey does not accurately reflect current provision of extended access services and it is essential that more work be undertaken to understand and address this. Areas for consideration may include understanding of the practice of questions being asked in the survey, lack of awareness of extended access services and potential service provision issues. Work will need to be undertaken with a particular focus on those CCG s where there are lower results for full provision. This work will be led by the HLP primary care transformation team working in partnership with the NHSE London primary care team. It will require input, resources and ownership from STP s and CCG s to take action at a local level to drive up improvements in achievements. The table below sets out a list of key actions which need to take place from November 2017 until March 2018 when the next survey takes place. Date Actions Who November Share information on achievement with STP HLP 2017 primary care for information and consideration of local action to be taken. Share information with STP and CCG access. HLP and STP Discussion at London Access meeting HLP & STP Leads Discussion with national lead and other regions HLP to understand data further. Individual discussions with CCG s with lower level results to ascertain any issues in regard to understanding of services in place. HLP and CCG s 4

5 December 2017 Sharing of information with NHSE STP Directors of transformation and delivery for information and action. Request for assurance from CCG s in the red/amber categories as to achievements. HOPC to consider approach to contractual action and communicate to CCG s as part of their delegated functions HOPC to raise results at delegated primary care committees and transformation boards that they attend for awareness and to encourage further local action. January 2018 Meeting with HLP Access lead and Heads of Primary Care to discuss support and action in regard to March survey including communication February 2018 Discussion of Survey at Access Delivery Group and actions to be taken. Feedback to be given to national team on any issues identified at London level. Comms to practices and CCG s including specific messages to those CCG s at the lower end of achievement to take local action. CCG commissioners to undertake local work to communicate and target practice response using practice level information. This is available via the NHSE website. Support could also be provided via the primary care embedded resources within STP s March 2018 Follow up Comms to practices, CCG s including specific messages to those CCG s at the lower end of Achievement in Sept 17. Liaise with national team to support understanding of progress and action to be taken on response rates during survey completion ( data is available via national and primary care web tool). HLP HLP HOPC HOPC HLP & HOPC HLP and STP HLP and STP HLP,HOPC, STP and CCG CCG s HLP,HOPC, STP and CCG HLP & HOPC 5

6 Appendix A Extended Access survey background information - Definitions of Classifications, Questions in the survey and Schedule for survey delivery I. Classification Responses to the survey are used to classify practices into one of three categories of extended access availability: Full provision - patients have access to pre-bookable appointments on Saturdays, and on Sundays, and on each weekday for at least 1.5 hours: in the early-morning before 8am, in the evening after 6.30pm or both in the morning and evening; through the practice or a group of which the practice is a member; Partial provision - patients have access to pre-bookable appointments on at least one day of the week, through the practice or a group of which the practice is a member, but the extent of extended access offered is not sufficient to meet the criteria of full provision; No provision - patients have no access to pre-bookable appointments outside of core contractual hours either at their own practice or through a group of practices of which their practice is a member; Practices which were invited to participate in the survey but did not submit a response are classified as No data. II. Extended Access Survey questions Extended access collection questions # Question 1 Do patients have the option of accessing pre-bookable Saturday appointments at your practice? 2 Do patients have the option of accessing pre-bookable Sunday appointments at your practice? 3 Do patients have the option of accessing pre-bookable early morning appointments (before 8.00am) during the week at your practice? 3a If YES to question 3, on which week days does your practice provide prebookable early morning appointments? (Tick those that apply). 4 Do patients have the option of accessing pre-bookable evening appointments (after 6.30pm) during the week at your practice? 6

7 4a If YES to question 4, on which week days does your practice provide prebookable evening appointments? (Tick those that apply). 5 What is the name of the group of which your practice is a member, for example this could be the name of your federation? 6 Do patients have the option of accessing pre-bookable Saturday appointments through your group? 7 Do patients have the option of accessing pre-bookable Sunday appointments through your group? 8 Do patients have the option of accessing pre-bookable early morning appointments (before 8.00am) during the 8a week through your group? If YES to question 8, on which week days does your group provide prebookable early morning appointments? (Tick those that apply). 9 Do patients have the option of accessing pre-bookable evening appointments (after 6.30pm) during the week through your group? 9a If YES to question 9, on which week days does your group provide prebookable evening appointments? (Tick those that apply). III. Extended Access Data Collection timetable Collection window open Collection window close September September March March September September March March September September March March September September March March 2021 Additional information on the survey including practice level response information can be found on the NHS England website 7