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Improving extended access to primary care in Greater Manchester

AMBS researchers evaluated two NHS schemes that provided 7-day access to general practice services across Greater Manchester

“The CLAHRC report provided vital evidence that was at the forefront of informing our decision to commit to rolling out extended access to the 2.8 million people living in Greater Manchester under our Primary Care Reform Programme.”

(Head of Primary Care Transformation at Greater Manchester Combined Authority)

Impact highlights

The research evaluating a GM pilot programme had an important influence on the NHS commissioning of 7-day access schemes across Greater Manchester. It also increased the accessibility and convenience of primary care service provision for 2.8 million patients across the Greater Manchester region, and helped develop an innovative evaluation methodology that informed the UK’s Department of Health strategies and service provision.

In summary, the results highlighted the benefits of 7-day access, which in turn led to the NHS in GM investing significantly in extended access provision.

Meeting the need for more accessible and convenient primary care

Policymakers have long suggested that primary care facilities have the potential to alleviate growing pressure on NHS hospital services by diverting patients from Accident and Emergency, and other urgent care services, to GP surgeries.

However, GP services are limited in their capacity to ease the strain on hospitals because historically they have not opened outside core weekday hours. In 2013, NHS England GM announced a £4.1m investment to improve GP access in Greater Manchester, and University of Manchester researchers partnered with Greater Manchester Health and Social Care Partnership (GMHSCP) to evaluate this programme.

Professor Ruth BoadenProfessor Damian Hodgson and Dr William Whittaker evaluated the potential of 7-day GP access to provide benefits to patients and the NHS.

Implementing 7-day access to general practice was a priority in GM following the devolved health and social care funding settlement in 2016, and coproduction between these researchers and the GMHSCP resulted in timely evidence for implementing this access.

The team’s first study, evaluating the GM pilot programme, provided key evidence to the GMHSCP and had an important influence on the commissioning of 7-day access schemes across Greater Manchester, which resulted in significant resource allocation from local and national health funds.

Informing the design of strategies and implementation plans

The first report by Professors Boaden and Hodgson and Dr Whittaker also shaped the design and implementation of the 7-day access scheme across Greater Manchester.

This report recommended six ‘enablers’ for the successful implementation of 7-day access, supported by an implementation checklist, all of which were referenced as critical enablers in the GM Primary Care Strategy.

One particular enabler suggested by the report – a sufficient primary care workforce – has resulted in further commitments to innovative service design and organisational change by the GMHSCP. The report led to the creation of a Primary Care Workforce Strategy Group (2017).

This research also influenced extended access to primary care nationally. Three of the seven core requirements published in national planning guidance draw on the results of both phases of the GPAF evaluation:

• Timing of appointments: specified to meet local population needs. GPAF and national evaluations showed that demand was not uniform across the weekend.

• Capacity: Evaluation by Manchester researchers showed that pilots were providing an additional 30 minutes of consultation time per 1,000 patients and this figure has been directly used in the planning guidance.

• Measurement: the challenges of identifying and measuring appointment activity were noted in reports by Manchester researchers and the national evaluations. Consequently, a new national tool was commissioned to automatically measure appointment activity.

Increasing GP service provision

Manchester research into the rollout of the 7-day access scheme helped to improve access to primary care and enhance service provision.

The Head of Primary Care Transformation at GMHSCP states that this evidence was ‘vital’ to the rollout of the scheme, which resulted ‘in an additional 1,500 hours per week of GP and practice nurse time being available to patients across the region’.

These additional hours equated to 51,806 extra out-of-hours appointments in 2016, with a significant increase in uptake by young and female patients, and a steady increase in uptake for weekend appointments. By 2019 extended access was available to all patients across Greater Manchester.