Same Day Access plan removed from ‘single offer’ in North-West London

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Following our representations, practices can now deliver the other services in the single offer without committing to the Same Day Access plan. 

Same Day Access will still be offered to practices, but participation is no longer a condition of signing-up to deliver the other services in the single offer for the 2024/25 financial year. The single offer is a package of services where practices signing up have to make all of the services in the package available to their patient population. 

This work was done in co-ordination with PCN clinical directors and patient groups, we believe it represents the best outcome for patients and practices. We have also seen a constructive dialogue throughout with commissioners despite the inherent tensions of the subject matter. ICB leads have indicated that they have reflected on and valued the feedback we have provided and are actively looking at how we can move forward positively. 

Londonwide LMCs and local LMC teams will be continuing these discussions, working with practices and PCNs to develop their own approaches regarding access for their patient populations. We will also continue to focus on addressing wider system pressures which are impacting on our ability to provide the care we want for our patients, such as inappropriate workload transfer to general practice. The goal is to deliver funding for general practice for the long term, working closely with commissioners and patients to ensure that any additional funds are deployed effectively, in support of practices and patients. 

Initial proposals

The Same Day Access plan would have seen patients requiring short-notice, acute care directed to hubs rather than their normal GP practice. Our concerns over this centred around the loss of continuity of care for patients and the impact on practices of having to split their staff teams across their existing sites and these hubs. 

At points there was also the suggestion that the hubs would have a greater reliance on a staff mix with more allied health professionals and ARRS staff working under the supervision of GPs than in a conventional practice. This also caused us concern about patients having less access to the expert generalist care that is the cornerstone of general practice.  

Practices in NWL were already implementing their own approaches to managing urgent appointments at a PCN level and we felt imposing a single model would mean this good work went by the wayside. It would also remove the flexibility to work in a way the meets the needs of differing local populations, that is a key element to the longstanding success of the UK model of general practice. 

This topic received substantial attention from GPs across London and had significant media interest, including national, local and specialist media.  

Chronology of communications

The main communications sent by us and the ICB can be viewed here, there were of course extensive face-to-face discussions around these, the conclusions of which are largely captured in the documents.