Kingston CCG update on Extended Access Services South of Borough Neighbourhood Committee Meeting 22 nd January 2019 Kathryn MacDermott Director Primary Care & Planning Kingston & Richmond CCGs
Kingston extended access provision • The Primary Care Extended Access Service became operational in December 2015 as a weekend service with utilisation of 42.3% • Weekday access started in February 2017 • The service is provided from three sites in Kingston: • Merritt Health Centre • Kingston Health Centre • Surbiton Health Centre • KCCG commissioned a borough wide door drop in summer 2017 • Practices also advertise the service • Overall utilisation hit 80% in December 2017 • Overall utilisation hit 80% again in September 2018 • Providing a continuous reliable service has also had a positive impact on service utilisation • NHSE London have set a 90% utilisation target to ensure investment and capacity is used appropriately 1
Kingston meets the London specification London specification Comparison to Comment National spec • Kingston provides additional access later in the evening (e.g. 5.00 – 8pm) to ‘top up’ the 8am to 8pm Monday to core hours access. Friday • Kingston meets and is above the minimum additional appointments to be provided. • Kingston was an early adopter of weekend access 8am to 8pm Saturday and • Kingston started the weekend services including nurse appointments to pilot Sunday appropriateness / utilisation • Pre-bookable appointments are made through the patients GP • Offer pre-bookable and Provision includes pre-bookable and same day appointments • same day appointments The service is advertised as a bookable service, when patients ‘walk - in’ they are allocated the next available appointment • Open to all registered Extended access is available to all patients registered with a GP in Kingston population in the area • The extended access services share the same clinical system as the Kingston practices Has access to medical • Patients medical records of all patients who access the extended services are available to records the extended service GPs • Accessible via multiple Appointments can be booked directly by 111 • routes including 111, online Appointments can be booked directly via the practice • and via the practice Online booking is work in progress Work in progress More stretching than National Same as National spec Key spec 2
However: • NHSE London have set a 90% utilisation target to ensure investment and capacity is used appropriately • KCCG has some learning from a review of its extended access services 3
Kingston extended primary care access utilisation Kingston Extended Apr 2017 - Mar 2018 Apr 2018 - Sep 2018 Primary Care Service Total provided Total Booked Booked % Total provided Total Booked Booked % (Appointments Offered and Mon-Fri 3,103 2,671 86.08% 1,472 1,339 90.96% Saturday 5,377 4,306 80.08% 1,690 1,537 90.95% Surbiton Hub Sunday 5,764 4,019 69.73% 1,944 1,710 87.96% Total 14,244 10,996 77.20% 5,106 4,586 89.82% Mon-Fri 2,989 2,513 84.07% 1,656 1,431 86.41% Saturday 4,086 2,295 56.17% 1,496 1,166 77.94% Kingston Hub Sunday 2,012 1,109 55.12% 719 445 61.89% Total 9,087 5,917 65.11% 3,871 3,042 78.58% Mon-Fri 2,868 2,469 86.09% 1,624 1,431 88.12% Saturday 2,408 1,148 47.67% 754 607 80.50% Chessington Hub Sunday 1,913 1,000 52.27% 748 384 51.34% Total 7,189 4,617 64.22% 3,126 2,422 77.48% Mon-Fri 8,960 7,653 85.41% 4,752 4,201 88.40% Saturday 11,871 7,749 65.28% 3,940 3,310 84.01% ALL HUBS Sunday 9,689 6,128 63.25% 3,411 2,539 74.44% Total 30,520 21,530 70.54% 12,103 10,050 83.04% The utilisation of the extended access hubs has continued to improve. However weekend utilisation and high numbers of DNA (did not attend) at the weekend indicate that we might want to consider how best to use this resource. 4
Summary of the hub review findings • Kingston was the first extended access service to introduce direct booking by 111 • The latest figures indicate that over 90% those patients booked by 111 attend the service (reducing the DNA rate) • Working age adults find the service the most convenient for themselves and their children • The weekday service has higher utilisation than the weekends • On the weekends Saturdays are more popular than the Sundays • 99% of presenting problems were for minor illness and only 1% for minor injuries • 48% of patient attending the extended access service report that they would have gone to A&E if this service was not available • Initially appointments were allocated to individual Practices based on their list , but many slots were left unfilled. An agreement was reached between Kingston GP Chambers and practices that allocation on the basis of list size was not required • All three sites receive excellent patient feed-back. 5
Who is using the service? Age Range of Patients Seen in Extended Access 100+ 4 90-99 103 80-89 545 70-79 980 60-69 1461 50-59 2137 40-49 2786 30-39 3393 20-29 3231 10-19 2038 0-9 5195 The majority of our patients fall into two sectors of the community • Young children • Working Age Adults 20 to 50yrs old 6
Weekend utilisation Practice Usage of Ext Access Appts as % of List Size 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Mon-Fri Usage Weekend Usage These appointments are booked directly by patients calling the service telephone number, on the day. A few weekend appt slots are available to practices to book their patients into on a Friday, if they have the need. All weekend appointments are also available to NHS 111 to book into directly, on a ‘first come first served’ basis. 7
Usage across localities: Chessington CHESSINGTON LOCALITY PATIENTS SEEN IN EACH HUB AS % OF TOTAL LOCALITY APPTS 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% CHESSINGTON KINGSTON SURBITON CHESSINGTON KINGSTON SURBITON CHESSINGTON KINGSTON SURBITON CHESSINGTON KINGSTON SURBITON Chessington Park HOOK Sunray Orchard 8
Surbiton SURBITON Locality Patients seen in Hubs as % of Total Appts 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% CHESSINGTON KINGSTON SURBITON CHESSINGTON KINGSTON SURBITON CHESSINGTON KINGSTON SURBITON CHESSINGTON KINGSTON SURBITON CHESSINGTON KINGSTON SURBITON CHESSINGTON KINGSTON SURBITON Berrylands Brunswick Central Claremont Langley Red Lion Rd 9
Kingston KINGSTON LOCALITY Patients seen in each Hub as % of Total Appts 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% CHESSINGTON SURBITON CHESSINGTON SURBITON CHESSINGTON SURBITON CHESSINGTON SURBITON SURBITON KINGSTON KINGSTON KINGSTON KINGSTON KINGSTON Canbury Churchill Fairhill Kingston HC St Albans 10
Patient feedback - Chessington Really good service, "Fine as things are now. Thank you", "Very good service", "Weekend is better for me as I work full time", "Please keep this surgery open. Thank you", "More publicity", "Very good. Quick", "I feel that the service I had was very good and the staff were very helpful", "Chose this location because it was earliest appointment", "Please continue this service. It is very helpful" "Nothing to be improved", "Already better" "Very nice doctor" "Excellent service - my notes available for duty Dr. It's a brilliant idea - any improvement would be to extend the hours“, "Good experience", "Excellent service. Quick service check in", "This is my first time and seen on time" "Fantastic, efficient service", "Excellent as it is", "Very helpful staff-got appointment straight away" "Useful service. Should continue", "Reception staff very helpful", "The doctor was very helpful and did all his best to help me which I was pleased with the results", "Good to have Saturdays morning", "Keep up a good work", "Great service, great advice, very friendly. Advertise more", "Fantastic service on time and antibiotic given. Thank you", "Great service, v. pleased" "Make evening/weekend appointment more easily available", "Great service. Thank you", "Service very good. Receptionist very welcoming", "Nothing all to improve", "This is very good out of hours surgery. I think this would prevent to go to A&E Hospital. Should be continuing", "Having access at weekends and evenings is extremely helpful as I have a family and easier to arrange a sitter-also have a child on the spectrum, so this facility is a lifeline. Please can his service be continued-it is excellent. Many thanks" 11
How patients hear about the service Where did you hear about the service? 90 80 70 60 50 40 30 20 10 0 Chessington Kingston Surbiton 12
The Winter communications campaign GP extended access channels • 3 x films promoting GP extended access • Website Banners • Stakeholder toolkit • Social media messages and graphics (Twitter/Facebook) • Double-sided A6 postcards, posters and pop up banners 13
The Winter communications campaign Social media 15
Winter Champions 16
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