The Prime Minister's Challenge Fund provided £50 million to improve access to general practice in England. Derbyshire and Nottinghamshire received £5.2 million to test new models of primary care delivery. The funds will be used to improve access through expanded hours, including weekends, and increased use of technology. Outcomes so far show that advanced nurse practitioners can effectively manage a high volume of same-day urgent appointments, freeing GP time for complex patients. Patient feedback has been positive about reduced wait times and availability of appointments. Evaluations will assess the impact on primary and secondary care utilization and costs.

1. Prime Minister’s Challenge Fund:
Transforming General Practice
in Derbyshire and Nottinghamshire
Dr Paul Oliver
Clinical Lead/Chair
Nottingham North and East CCG

2. What is the Challenge Fund?
Patients and stakeholders have told us access to general
practice services need to improve.
• In response, the Prime Minister launched the ‘Challenge Fund’, with:
• £50m to help improve access and stimulate innovation by testing new
ways of working
• 250 expressions of interest received in January 2014
• 20 selected pilots across England announced in April 2014
• Derbyshire & Nottinghamshire “collaborative” bid success (£5.2m)
• 12 month project, consistent with local 5 year strategy

3. Benefits to our patients
To be tested in selected practices/areas:
• Ability to be seen in primary care at a convenient and appropriate time, 7
days, Sat and/or Sun
• Longer appointments for people who need them
• Increased patient education and opportunity for self-care
• Choice of technology for real-time appointments and monitoring conditions at home
• GPs supporting more patients at home and out of hospital with personalised care
• Helping patients get the right care, at the right time, in the right place, so they
live longer, healthier lives
NB: NOT ALL INTERVENTIONS WILL BE TESTED IN EVERY PRACTICE

4. What will be tested?
Improving quality for 1.2m patients locally from 85 practices
across Derbyshire and 71 practices across Notts, including:
• More appointments, 7 day services, Saturday and/or Sunday through
locality hubs for up to 537,000 patients by March 2015
• New ways of communicating (e.g. email/Skype) for 328,300 patients by
March 2015
• Choice - ability to access services from other GP sites
• Introduction and roll-out of telecare so patients can help manage own care
• Joined-up services between the GP and the hospital with GPs responding
to avoid unnecessary increases in A&E and admissions

5. Prime Minister’s Challenge Fund:
GP Same Day/Urgent Care pilot
Nottingham North and East CCG

6. NNE CCG bid
GP services in Arnold, Carlton and Gedling will provide
patients with:
• Increased access up to seven days a week
• Rolled out to 20,000 patients across two practices from Sept 2014
• Available to 61,400 patients across nine practices from March 2015
• A community health hub to improve access to same day urgent care and
routine care up to seven days a week
• Free up GP time to manage complex patients more effectively
• Opportunities to visit other general practices in area and utilise
technology to provide a range of consultation options

7. Urgent Care Analysis – NNE CCG
Over one week at one practice:
• 379 requests for a same day appointment
• GP validation suggested 50% of patients in this audit could have been
seen on the same day by an advanced nurse practitioner
• A total of 7 home visits were made as ‘urgent’
• If an appointment is 10 minutes, this frees up 29 hours of GP time

8. Aims
• Test alternative patient pathways for managing same day/urgent care in
general practice across 9 GP practices
• Refer patients to the locally-based health and social care professional
team aligned and working to the general practices, known as the
Extended GP Team
• Support practices in pilot to work together across the locality to rotate
clinical staff into the team to deliver an 8-8/up to 7 days service offer
• Release GP time and enable increased proactive management of more
complex patients

9. Outcomes to date
• Advanced Nurse Practitioner - 1 day a week in Practice 1
from 1st April 2014 to beginning of May
• 3 days a week from 7th May 2014
• Around 30 patients are seen each day
• Approximately 500 in total to date

10. Outcomes to date
• Out of 500 patients only 4 have needed to be seen for further
assessment by GP
• Common presentations: urinary tract infections, chest
infections, ear pain, rashes, hay fever, sore throats/tonsillitis,
gastroenteritis, animal bites, gynaecological problems,
conjunctivitis

11. Patient feedback/consultation
• 30 patients took part at practice 1
• 100% were satisfied
• No difference to the level of care provided by the GP
• Shorter waiting times than A/E and WIC
• 90% would travel to another location close by
• 83% would consider telephone or online consultations

12. Patient feedback/consultation
A lot faster. No waiting to the end of the day.
Very good. Prefer it to normal appointments. It has
been a long time coming. There are a lot of things
you don't actually need to see your Dr for. But you
have to book an appointment which takes up time
that someone who is more needy could have had.
Big improvement as GPs do not have time for minor
ailments.

13. Developing the model

14. Quantitative clinical audit
• Centre for Health Innovation, Leadership & Learning (CHILL), Nottingham
University Business School
• An assessment of the extent to which the reallocation of GP and practice
resources have impacted day-to-day activities for same day/urgent care
services on long-term chronic care services
• The audit will use a specially designed metrics toolkit containing a set of
well-designed indicators that link together staff utilisation and treatment
with questionnaire data on patient demand and staff experience.
• Staff questionnaire
• Patient questionnaire

15. Challenge Fund scenario model
• Inputs the cost of the scheme
• Input the assumed benefits in secondary care – across
specialty
• Models cost of scheme against break even from reduction in
acute provider costs
• Can be expanded to include all other providers and metrics
from the system plans

16. Thank you.
Any questions?