Enhanced Access is here!
Enhanced Access is the service that practices are going to be delivering together, within their Primary Care Networks, from 1st October. This service means that these networks of practices are going to offer evening and weekend appointments, at a variety of locations in the local area, that are open to all their registered patients. The key difference between this and the additional hours that practices have offered previously, is that these appointments will be on a shared appointment book, and practices will be able to book their patients in at other practices and locations within their network. It is now a shared responsibility across the Primary Care Network member practices to deliver the required number of appointments each week, rather than each surgery simply being responsible for its own service and patients.
Whilst this may seem like a reasonably straightforward change, the logistics of this are quite complex. It means that practices’ clinical systems need to be able to talk to each other, firstly. This must include the ability to view, book into, and cancel appointments, make referrals and request tests, to view and update patients’ records, and for all relevant staff to have the ability to access all patients’ medical records within the PCN. EMIS and SystmOne, the two systems that are in use within Doncaster practices, have required some intricate configuration and testing to get up and running with this – both in terms of each system on its own, and the interface between the two.
It also means that these appointments need to be staffed, with appropriately skilled clinicians who are identified and booked into shifts in plenty of time so the appointments can be published – without the clinician’s name, the shared appointment book cannot “go live”. This has required a lot of work in rota planning, and having the right processes in place so that practices are assured that the clinicians are appropriately trained and competent. It also needs management support to be on hand in the case of last-minute cancellations, to find replacement staff or to re-book patients into alternative slots. And the clinics themselves need both receptionist and on-call support in order to run smoothly and safely.
Practices are also required to report on the activity within Enhanced Access, to give the commissioners assurance that the number of hours is being delivered on a weekly basis. They need to monitor the utilisation of the appointments too, regarding which practices are using which slots, for which patients, at which times. This is a change from previous arrangements, as the activity previously delivered at practice level was not subjected to this level of scrutiny.
And finally, the communication and engagement of both staff and patients, in the lead up to this change, has been a constant priority. Practice staff need to know how to book patients into the appointments; the Enhanced Access staff need to be able to navigate the shared systems to be able to treat the patients, and know who to call on for help with anything; and patients need to know what to expect and what changes are being made to their services. This has required a constant flow of information as it has become available, out to the public and practices alike; and this has sometimes been a challenge, as the mobilisation of the service has been up to the wire in some cases!
These various workstreams, encompassing digital, workforce, analytics and communications, have been facilitated by a lot of hard-working teams across PCNs, practices and PCD in the last few months. North PCN is running this with resources from within practices; the other four PCNs (East, Central, South and 4Doncaster) have sub-contracted the co-ordination of the service from PCD. It is inevitable that in the first few weeks of the new service, there will be teething problems that we will all need to work together to solve. However, we should take confidence in the collaborative relationships that we’ve all worked so hard to build; which will surely, in the words of Clint Eastwood, allow us to “adapt, improvise and overcome”! Thank you to all the staff that have worked with tireless dedication and commitment so far, for the benefit of Doncaster patients. Let’s continue on the Enhanced Access journey with optimism!
Laura Sherburn, CEO