Alliance Manchester Business School's Health Service Research Centre (HSRC) present the first in a series of research seminars:
Natalie Ross, Will Whittaker, Damian Hodgson, Pauline Nelson, Laura Anselmi, Caroline O’Donnell and Katy Rothwell
Since 2013, extended access to general practice in England has been a national health policy priority, with the GP Access Fund (GPAF) and General Practice Forward View (GPFV) providing financial support to CCGs for expanding primary care provision. In Greater Manchester (GM), the recent roll-out of 7-day access arrangements across 7 CCG areas has been evaluated by NIHR CLAHRC GM. Areas submitted plans for 7-day primary care provision to NHS England in mid-2015, to run throughout 2016.
The research team carried out a mixed methods evaluation to answer the following research questions:
(a) How has 7-day access been implemented in GM?
(b) How have patients responded to the 7-day access service?
18 semi-structured interviews were carried out with NHS commissioners and providers to determine organisational and operational issues arising in the implementation of 7-day access, and how areas addressed them. In addition, 7-day activity and appointment data from each of the CCG areas was collected to provide an assessment of the demand and uptake of the service.
The evaluation found substantial variation in the provision of 7 day access across GM in terms of the number, and type, of ‘hubs’, extent of hours, and range of services provided. Some areas were operating a full suite of services and struggling to cope with demand, whilst others were struggling to get the service off the ground. The number of hubs in each of the areas ranged from one to four, whilst the type of estate used ranged from small private practices to brand new primary care services centres. The demographics showed that hub-based practices dominated use. In addition, extended appointment users were predominantly female, and disproportionately younger than core hour users (measured via the GP Patient Survey). With regards to uptake, whilst initially it was highest through the working week and lowest on a Sunday, uptake improved throughout the period (including on a Sunday).
The evaluation suggests that different implementation strategies reflect different contexts and also different conceptions of 7-day access. Extended appointments appear to be meeting a demand comprised of working aged adults during the week, and children at weekends. Uptake trends suggest assimilation is important, whilst hub dominance affects the extent of service provision. In light of these findings, the delivery of a 7-day service needs to take into account the context of local populations, focus on raising awareness of access and supporting engagement with the service.
Light luncheon refreshment will be provided at the beginning of this seminar.