LMC concerns re: North West London ICB proposed access service

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In light of recent commissioning decisions, and given interest from  practices across the Capital, we want to update you on developments in North West London.

Commissioners are seeking to introduce a new model of care for Same Day Access, and to incorporate it as a mandatory component of the NWL Single Offer of Local Enhanced Services from 1 April.

We have been engaging with local LMC members and PCN CDs regarding their views of the proposals.

Londonwide LMCs, representing LMCs and GPs within NWL and across the Capital, have ongoing reservations about the model of care and the speed of the rollout.

We understand that this model has been driven by recommendations in ‘The Fuller Stocktake’ which recognises the need to address same day access requirements, but it does not mandate this model as the necessary solution to this issue. Indeed, it specifically states ‘A personalised care approach means ‘what matters to me, not what’s the matter with me’.

GPs across NWL have raised significant concerns around:

  1. Patient safety
    1. Clinical triage
    2. Limits of clinical competency
    3. Unsafe clinical supervision arrangements
    4. Meeting the needs of unregistered patients
  2. Clinical quality and effectiveness of care
    1. Impact of loss of personalised care and continuity of care
    2. Widening health inequalities
    3. Driving up demand for clinical advice and care for self-limiting conditions
  3. Logistic concerns
    1. IT functionality
    2. Estates
  4. Patient experience and public consultation
    1. Patient experience
    2. Public engagement and consultation
  5. Impact on staff and retention
    1. Impact of implementing change
    2. Staff experience
  6. Perception of ‘enforcement’ despite immense concern
    1. Inflexible contracting approach
    2. Appropriate use of funds

All GPs are invested in optimising the patient experience of accessing care, and we will continue to be clear that the ultimate limiting factor of timely patient access is a gross mismatch between demand and capacity. We need to recognise that, as a system, we are offering more appointments than ever. In NWL this is in the context of one of the lowest GP to patient ratios in the country.

A shift of this magnitude in the way of working would require a safe, effective model of care to meet patient need, and a change management process over time. It is clear from feedback we have received that there is immense concern regarding this model, with unrest heightened by: the proposed timescales; the desire to mandate this as part of the single offer which is being seen as an enforcement; the lack of outcomes as yet from a reliable, valid, comprehensive, fair and ethically conducted pilot programme.

We remain in active dialogue with commissioners and have asked a series of questions, seeking reassurances and clarifications. We have also asked who has clinical accountability within the ICB for this model so that we can escalate any outstanding concerns appropriately.

There will be further developments over the coming days and we will continue to update you as circumstances develop.