Open all hours

The Watford Care Alliance was highlighted as a Challenge Fund success story in health secretary Jeremy Hunt’s new deal speech. Herts Valley is looking to expand the pilot’s services in the area

As commissioners, we are always looking for new ways to support and provide better healthcare and access to services for our patients. The Watford Care Alliance (WCA) pilot, a successful bidder in the first wave of the Prime Minister’s Challenge Fund, is an innovative and exciting project that could have significant implications for how we organise primary care services in the future.
The pilot brought together 12 GP surgeries in the Watford and Three Rivers area to offer patients extended weekday evening sessions, weekend opening hours and a phlebotomy service.
In just one year the WCA has offered an impressive 12,000 additional GP appointments to patients in the pilot area, which has a population of around 110,000 people.
At Herts Valleys Clinical Commissioning Group (CCG) we have been actively supporting and monitoring the WCA pilot since it began in 2014, as the practices involved are our members. More recently we have agreed additional funding of £203,000 to extend it until the end of March 2016.

How extended opening and weekend services work
Patients registered with a practice in the pilot area are able to access appointments with a GP from 6.30pm until 7.40pm on weekday evenings and 9am to 12.30pm and 3pm to 7.40pm on Saturdays. On Sundays GP appointments and a phlebotomy service are available between 9am and 12.30pm. All surgeries take turns to provide the service, so an extended hours or weekend appointment could be with a GP from another practice.
Patients registered in the pilot area can also make an appointment with a GP through the NHS 111 telephone service, which is available 24 hours a day, 365 days a year.

Progress
Since the pilot began, a great deal has been achieved. All 12 GP practices have agreed to share information, with the appropriate consent, and see each other’s patients.
Practices are using new technology systems such as the Medical Interoperability Gateway to view patient clinical records held by a patient’s usual GP, and Adastra, which allows the GP to record details from a consultation and send the details to the patient’s usual surgery.
Patients in the area also have access to a WCA GP as part of the Community Rapid Response Service. They provide support to patients at home if this is medically appropriate and minimise admissions to hospital. The service also enables some patients to leave hospital earlier by offering continued support for them at home.
There has been considerable learning along the way, from training staff to use the new appointment booking system to GPs delivering clinical sessions in other practices. To help coordinate the alliance, a monthly committee was set-up at the start of the project to bring together GPs and practice managers from all of the practices. Patients have been involved in the project from the start, helping to develop services and they continue to be consulted as the pilot progresses.
There are two other work streams that form part of the WCA that are in the early stages of development. These are focusing on improving integration between local health and social care services, and introducing new technology to support service access, such as telecare.
These are not easy changes to bring about. Integration of processes and cultures require significant adjustments. Twelve different surgeries may have different views on how things should look and integrating information technology can be fraught with difficulties. It speaks volumes about the vision of the clinical leaders and willingness of the partners to work together.

Patient feedback
So what do the patients think of extended opening so far? The WCA has already had some very positive feedback in the surveys it collects from patients using the service.
When asked if they would use the service again, 99% of people said they would; while 99% of those questioned said they would recommend it to family and friends, and 93% rated the care they received as excellent or good. Fourteen per cent of patients said they would have gone to A&E and 18.7% said they would have used out-of-hours GP services if they had not been able to see a GP on the day.
Specifically patients have said:

“It really helps with looking after
my own health while fitting in work
and life.”
“Great to see a doctor instead of going to A&E on a bank holiday.”
“Very good for people who have full-time jobs and do not have flexible working hours.”
“As a working mum I really value out-of-hours appointments.”
“Evening and weekend service is brilliant and really needed. Keep up the great service.”

Next steps
After a year of piloting extended opening hours, the indications from patient surveys are potentially exciting but it is too early to say anymore with certainty. The WCA model has been well received by patients and offers choice and flexibility to suit their busy lives. Significantly, it may help them to avoid a visit to A&E or an extended stay in hospital.
In the autumn Herts Valleys CCG and our local partners are due to publish options for how health and social care services might look in west Hertfordshire. This follows a review during the last 12 months with extensive consultations of local people, called Your Care, Your Future.
As we look to improve services within the finances available, primary care and the WCA model will have a central role to play in shaping the future. In the meantime Herts Valleys CCG is keen to better understand the wider impact of extended hours. For example, what does this mean for other local services, such as hospitals, urgent care and social care? Are there any specific health benefits for patients? What’s the impact on planned care? What are the implications for us as commissioners and will there be savings for the wider health economy?
Up until the end of March 2016 we will be collecting and examining further data with our acute partners and others to help us answer some of these important questions.

Nicola Bell, accountable officer at Herts Valleys Clinical Commissioning Group.