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Delivery strategies

  • Last modified date:
    9 February 2007

Sustainable modernisation at practice level and effective management by PCTs

The national delivery strategy

This involves two main components:

  • Sustainable modernisation at practice level - this bottom-up approach is led by the National Primary Care Development Team (NPDT) and promotes primary care modernisation with individual practices. This approach can go a long way towards improving the working lives of GPs and their staff.
  • Effective Management by PCTs backed by identified resources - a managed approach through PCTs who are responsible for the achievement of the target through the local delivery plan (LDP) process.

SHAs have used PCT local delivery plans to develop their own plans which indicate how the target will be delivered across their area, reporting progress on this to the DH Performance Management Programme Board. They are also supporting PCTs to develop local strategies which involve the Modernisation Agency's Changing Workforce Programme and the 11 NPDT Centres.

PCT Strategies

1. Advanced Access - what it can do for you

The model - the Advanced Access model is a National Primary Care Collaborative (NPCC) modernising initiative which is managed by the National Primary Care Development Team (NPDT). It consists of a framework of change principles and change ideas grounded in practical examples and drawn from general practice. The change principles are:

  • Understanding the profile of demand in terms of number and types of requests for appointments
  • Shaping the handling of demand to safely and effectively reduce demand for face-to-face consultations with GPs
  • Matching the capacity of the practice team to the shaped demands of patients
  • Establishing robust contingency arrangements to deal with staff holidays and sickness, and peaks in patient demand (epidemics for instance).

The benefits - Practices using the Advanced Access model have delivered impressive results in improving access because they have developed a better understanding of their demands and are using proven strategies for managing this demand more effectively. A key element of this work has been improving skill mix within the practices, making more effective use of highly-skilled nurses and increasingly using health care assistants to enable nurses and GPs to target their skills more appropriately.

Results by July 2003:

  • NPDT working with over 4,000 practices responsible for 27 million patients - this is set to increase to 37 million by March 2004.
  • Up to a 70% reduction in waiting times to see a GP
  • Up to 50% reduction in waiting time to see a practice nurse

How to participate

The NPDT are actively disseminating the Advanced Access model through their network of local NPDT centres which have direct links to SHAs. A key role of the centres is to facilitate the contribution of other existing sites, project managers and practices in the area to deliver this effectively across a broad geographical area. Click  the link below for the eleven NPDT Centres - Contact Details

Information on the work of the NPDT and the Advanced Access model for improving access in primary care is available by clicking on the link below to the National Primary Care Development Team (NPCDT) website

2. Other strategies - learning from others

See the individual sections below by scrolling down the page

  • i.  NHS Walk-in Centres
  • ii. Pharmacy-based minor ailment schemes
  • iii. PMS
  • iv. Service reconfiguration
  • v.  PCT flexibilities
  • vi. New GP contract arrangements

i - NHS Walk-in Centres

The 42 NHS Walk-in Centres (WiCs) were developed as part of the wider plan to modernise and improve access to and convenience of NHS services. They are a resource intended to help people make better use of the NHS, to help professionals make better use of their skills and to respond to modern lifestyles. Because of their extended opening hours they provide a service to people who find it difficult to access primary care during working hours, at weekends and bank holidays.

In recognition of the success of the WiCs and of their potential to address specific local access issues, a new tranche is now being developed and13 sites have already been identified with more to follow over the next two years. It is intended that the new centres will be operational this winter and their outcomes will be monitored and evaluated to inform wider roll out.

Examples of how WiCs can contribute to the achievement of the target include:

  • Host PCTs working with existing WiCs in their area to develop the maximum contribution to improving access
  • Experienced WiC nurses providing training and support in local practices
  • Setting up WiC satellite services in the community in areas where existing access is poor
  • Developing new WiCs to resolve capacity problems which are inhibiting the ability of PCTs to achieve the target. The focus of the new WiC would be to offer choice for patients and to support local practices to improve access for patients.
  • Developing Walk-in Centres or services as part of PCT NHS LIFT programmes.

Case studies and networking contacts:

Croydon WiC has supported the development of an 'open access clinic' in the area. Patients who are unable to see their GP within the access target timescales are offered an alternative appointment with an experienced primary care nurse or nurse practitioner.

Contact: Andrea Bellot - Project Manager, Croydon NHS Walk-in centre, andrea.bellot@croydonpct.nhs.uk

Whitechapel WiC has two part-time salaried GPs and is also piloting a GP access service which is used by local GPs when they have no available appointments. GPs are available at the WiC between 8am-6pm weekdays and 9am-6pm at weekends and Bank Holidays. Appointment slots are available every morning, alternatively practices can refer patients to the WiC.

Contact: Helen Davies - Project Manager, Whitechapel NHS Walk-in Centre, helen.davies@whitechapel-wic.nhs.uk

Leigh WiC - nurse practitioners from the WiC are working two days a week at a local GP practice to see patients presenting with minor ailments that do not require the skills and expertise of a GP.

Contact: Gail Gaskell - Lead Nurse, Leigh NHS Walk-in Centre gail.gaskell@wiganlhs.tr-nwest.nhs.uk

Nottingham WiC nurses go out to local practices to support and train practice nurses.

Contact: Ann Simpson - Project Manager, Nottingham NHS Walk-in Centre ann.simpson@emid.nhsdirect.nhs.uk

Manchester Airport WiC has recently opened a new centre in a temporary site near Wythenshawe town centre providing improved access for local people. The centre will move next year into a new NHS LIFT development.

Contact: Richard Desir - Project Manager, Wythenshawe NHS Walk-in Centre desirr@manchester.nwest.nhs.uk

Useful links

  • Information on NHS WiCs is available on the NHS website (click on the link below)
  • Further advice and support on how to develop a WiC is available from the DH WiC Implementation Team through the PC Access Mailbox at  MB-Access@doh.gsi.gov.uk

ii - Pharmacy-based minor ailment schemes

Pharmacy-based minor ailment schemes provide an alternative way of treating people with minor ailments who do not need to see a GP. Such schemes have been established in around 20 PCTs, and have proven highly successful in helping GP practices to manage demand and improve access. A formal evaluation of a scheme in Bootle showed that GP workload for minor ailments was reduced by 9% following the introduction of such a scheme in a practice that already ran an open access nurse-led clinic. More details about the 20 current schemes can be found by clicking on the link below.

The NPA, University of Keele, and Northumberland Tyne and Wear Strategic Health Authority have developed a toolkit to support PCT commissioning of pharmacy-based minor ailments services. This includes details of best practice from tried and tested schemes. More details can be found by clicking on the link below to the community pharmacy minor ailment resource area on the NPA website.

Pharmacy based schemes are particularly valuable for patients in deprived areas who are more likely to consult a GP to obtain free treatment for minor ailments on prescription.

Case study and networking contact

Peterborough PCT is running a pilot which allows patients who are eligible for free prescriptions for certain over-the-counter medicines to go direct to the pharmacy - taking away the need for a GP appointment.

Contact: Greater Peterborough Primary Care Partnerships-North Peterborough Primary Care Trust. Click on the link below to visit their website.

iii - PMS

The 24/48-hour access has been a component of the PMS Framework Agreement from wave 3. The new contract arrangements mean that PMS will become mainstream and there is now an opportunity for PCTs to maximise the impact of PMS on the achievement of the target.

Examples include:

  • PMS practices that are unable to provide 24/48 hour access being encouraged and supported to take up the Advanced Access model
  • PMS practices being developed as a resource to supplement and support existing services to improve access locally
  • Increasing the focus of PMS practices where access is not included as part of the contract - through the negotiation and agreement of specific objectives as part of the contract variation process
  • Sharing of information and/or the development of joint working arrangements with other PMS schemes which are achieving the target.

Guidance will be issued shortly on how PMS will be mainstreamed. In the meantime, for more information see the Personal medical services pages

Case studies and networking contacts:

Greenwich PCT has developed PMS Alpha where Advanced Access principles have been included within the PMS contract and working towards these principles forms a significant part of the PMS scheme objectives.

Contact: click on the link below to visit the Greenwich Primary Care Trust website.

Loughborough PCT has co-location of the PMS pilot and the WiC providing a 24-hour service for the assessment and treatment of minor ailments and injuries.

Contact: Frank Durning - Project Manager, Loughborough Walk-in centre frank@durningf.freeserve.co.uk

Peterborough PCT have developed a new integrated primary care centre in the Rivergate Centre bringing together a new PMS pilot to support both the provision of out-of-hours services and the co-located Walk-in centre. The integrated centre also provides evening and night community nursing, social services and a rapid response team. In addition, a variety of 'drop-in' clinics will be held in this spacious new site, increasing patient access to a wide range of clinical services.

Contact: Greater Peterborough Primary Care Partnerships - North Peterborough Primary Care Trust. Click on the link below to visit their website

iv - Reconfiguration

Service reconfiguration is increasingly being used by PCTs to rationalise or improve service provision and to make the best use of resources available to them. This approach is also being used by PCTs to improve access to services in primary care.

Examples include:

  • The development of new integrated services which bring together a range of services under one site
  • The re-design of the existing nursing and AHP workforce to develop a team approach to delivering first contact care
  • Development of healthcare assistants and other staff to undertake more routine tasks - with proper supervision and subject to strict protocols
  • Partnership working between general practice, community services, MIUs and A&Es to provide improved and cohesive access to services in rural areas
  • The introduction of new community pharmacy and minor ailments schemes. Details about the 20 current schemes can be found by clicking on the link above to the PDF Community pharmacy minor ailment schemes at June 24th 2003

Case studies and networking contacts

A GP in Wellingborough led the development of a first contact team of two GPs and two nurses who provide open access for patients with same-day appointments, while protecting time for other GPs in the practice to care for patients with chronic diseases. The first contact team undertakes around 100 consultations a day.

Contact: Dr. Derek Gallen, Wellingborough Practice dgallen@supanet.com

In Milton Keynes a number of practices have developed the skills of health care assistants and the role of receptionists to undertake work traditionally performed by practice nurses. In one surgery, the health care assistant records blood pressure and takes blood samples for analysis.

Contact: Milton Keynes Primary Care Trust at mail@miltonkeynes-pct.nhs.uk

Wycombe PCT has introduced a minor ailments service linked to local pharmacies which reduces the number of GP appointments.

Contact: Wycombe Primary Care Trust. Click on the link below to visit the website - The NHS in Buckinghamshire & Milton Keynes

v - PCT flexibilities

PCTs have been given increasing power, resources and flexibilities to allow them to provide a range of services that meet the needs of the local population.

Examples include:

  • The ability to commission services from the independent sector
  • The employment of PCT salaried primary care professionals
  • The development of pools of staff across neighbouring PCTs.

Further information on PCT development is available from the National Primary and Care Trust Development Programme (NatPaCT) - click on the link below to visit the website.

Case study and networking contact:

Durham Dales PCT and Bishop Auckland General Hospital are working together to expand the Urgent Care Centre which is run by the out-of-hours co-operative. The PCT employs a GP and a nurse, allowing patients to be directed to the UCC in the afternoons if they have requested a same day appointment. The nurse triages the patient by phone and gives patients an appointment at the UCC with either herself or the GP if appropriate. Durham Dales PCT also employs a G Grade nurse to telephone triage home visits for GPs. Where appropriate she undertakes visits herself.

Contact: The Durham Dales Primary Care Trust website by clicking on the link below.

vi - New GP contract arrangements

The new GP contract has now been agreed and will be implemented from April 2004. The new practice-based contract provides for GPs to be rewarded for improving access as a Directed Enhanced Service (DES) through the award of 50 points towards the Quality Outcomes Framework. Further information will be posted on this site once the detail of the arrangements is available.

Where practices opt out of providing improved access as a DES, PCTs should look to the other strategies such as those set out in this toolkit to achieve the target.

Useful links

More information on the new GP contract is available from:

  • The Department of Health at GP contracts
  • The British Medical Association website

Supporting legislation will also provide for PMS practices to receive comparable benefits for improved access. This provides the opportunity to further develop PMS practices to support local improvements in access.

Click on the link above to the Personal medical services pages

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