Appointment Management using GP Connect

The Clinical Commissioning Groups (CCGs) of Fareham and Gosport and South Eastern Hampshire established a formal partnership with North Hampshire and Isle of Wight CCGs to help accelerate improvements in patient care, be more effective and reduce duplication. By working together, the Partnership shares capacity and skills and operates with greater consistency for the benefit of patients.

In East Hampshire, Fareham and Gosport and South Eastern Hampshire CCGs serve 432,560 patients across the Fareham, Gosport, Petersfield, Whitehill and Bordon, Waterlooville, Emsworth and Havant areas and work with thirty-seven GP practices.

In common with all CCGs, Fareham and Gosport and South Eastern Hampshire were tasked under NHS England’s Improving access to general practice initiative to ensure that everyone has improved access to GP services including sufficient routine appointments at evenings and weekends to meet locally determined demand, alongside effective access to out of hours and urgent care services. The initiative set out plans for CCGs to commission and fund additional capacity across England to achieve this.

The practical implications of the initiative are that GP practices need to extend practice opening hours and allow patients to book appointments with GPs at other practices if convenient via extended access hubs.  The 2018/19 GMS Contract also stipulated that NHS 111 should have the ability to book appointments for patients directly into GP appointment schedules. Targets around these challenges include:

• one appointment per 3,000 registered patients per day should be made available to NHS 111 for direct appointment booking
• extended access provision available for out of hours and the ability for clinicians to view patient records at the Extended Access Hub

The CCGs awarded the Southern Hampshire Primary Care Alliance a contract to provide all practices extended access appointments and out of hours appointments.  The technical solution originally used by the Alliance was EMIS clinical services and Remote Consultation software as thirty-six of the thirty-seven practices use EMIS as their principle clinical system.  This was found to be clunky and time consuming for practice staff and they could not access the TPP system for the one surgery using SystmOne as their principal clinical system. As a result, both the system and service were not fully utilised and manual workarounds were introduced.  There has been a long-recognised issue of lack of interoperability between the GP clinical systems which has created a barrier to seamless sharing of patient information and appointments.

What was required was a more efficient and effective way of managing extended access and out of hours appointments across all thirty-seven of the GP practices. In support of this a solution to allow record sharing across all practices was also required.

In pursuit of this, the local team contacted the GP Connect Team.

Following discussions between the Alliance and the GP Connect team, a use case was agreed that would address the challenge of extended and out of hours appointment sharing and booking as well as patient record sharing.

The Alliance’s vision was to provide an IT interoperability solution for providers and general practice alike. What started as a request for a single practice using TPP SytmOne to access appointments on the EMIS system and for NHS 111 to directly book into general practice was growing at a pace with the added challenge of Primary Care Networks (PCNs). PCNs need a technology platform to enable them to set up services and refer across the patch.

It was recognised that GP Connect could enable:

• the CCG TPP SystmOne practice to see and book extended hours appointments for its patients
• direct appointment booking from the South Central Ambulance Service NHS111 service to primary care systems
• viewing of patient records - this is timely to support the direct booking of calls from NHS 111 into GP surgeries nationally as per the GP specification, as well as some of the ongoing enablement aspirations within the Primary Care Network.

For the one GP Practice using TPP SystmOne, the GP Connect configuration was straight forward.

Initially it was noted that the Extended Access Hubs did not have ODS Codes and so these had to be applied for via the ODS Team at NHS Digital. Once available these were used by EMIS to configure the local sites. When GP Connect was enabled, the GP Extended Access service staff were not using Smart Cards to access their system as EMIS Remote Consultation did not require them to. It was identified that for GP Connect to work as designed, all staff would need to use Smart Cards. To enable access the Hubs were required to purchase RDS access from EMIS which took some time and delayed the project start.

Whilst waiting for this access, the CCGs learned that South Central Ambulance Service (SCAS) was working with the GP Connect Team with a view to undertake a First of Type with Advanced for NHS 111 direct booking into General Practice. It was agreed that the practices and EA Hubs would also share data with SCAS to allow Direct Booking and Access Record: HTML to improve patient 111 experience and outcomes.

In order to keep practices informed of the local plans and the impacts on them in terms of technology and business change, the CCG designated a member of staff who was given the role of Practice Configuration and Implementation Lead. This role involved working across the stakeholder groups to move to an effective deployment of the technology and to address the operational needs and concerns across the GP practices and EA Hubs. Throughout the deployment the process was changed and adapted to incorporate lessons learned, particularly in response to feedback from practices that not enough guidance was given in relation to local expectations to meet the GMS target for direct booking into General Practice.

Lessons learnt from pre-implementation include the need to:

• establish a clear understanding of the GMS contractual requirement - local protocols should be developed at CCG or STP level in order to provide guidance to practices in terms of the expectations on them
• understand your local estate and the supplier systems in use - is there anything that could stop GP Connect from working, for example, practices using systems for appointments which aren’t compliant with GP Connect standards?
• secure buy in and engagement with all of the GP Practices and EA Hubs from the start of the project - this is fundamental to achieving a successful outcome
• ensure that practices are clear on their obligations before go live - this is key to a smooth deployment for all parties.

After implementation the CCGs have reported that GP practices now feel that their concerns about new ways of working with GP Connect for appointment management were unfounded and the myths around 111 access to the GP system were not seen to be true.  33 of the 37 practices are accepting NHS 111 direct booking into their appointment schedules. Although the appointment allocation is not always fully utilised by NHS 111, processes exist locally to allow these appointments to be booked as usual by practice staff should the need arise.

National Standards for Urgent Treatment Centres (UTCs) (Published in August 2017) stated that patients and the public will:

• be able to access UTCs that will be open at least 12 hours a day, GP-led, staffed by GPs, nurses and other clinicians, with access to simple diagnostics, for example urinalysis, ECG and in some cases X-ray
• have a consistent route to access urgent appointments offered within 4 hrs and booked through NHS 111, ambulance services and general practice - a walk-in access option will also be retained
• increasingly be able to access routine and same-day appointments, and out-of-hours general practice, for both urgent and routine appointments, at the same facility, where geographically appropriate
• know that the UTC is part of locally integrated urgent and emergency care services working in conjunction with the ambulance service, NHS111, local GPs, hospital A&E services and other local providers

UTCs aim to ease the pressure on hospitals, leaving other parts of the system free to treat the most serious cases. The UTC offer will result in decreased attendance at A&E, or, in co-located services offer the opportunity for streaming at the front door. All UTC services will be considered a Type 3 A&E.

GP Connect will be used to enable NHS 111 direct booking of appointments into the UTC.  Clinicians in the UTC will also be able to directly book patient back into appointments with their registered GP practice or an Extended Access Hub locally should the patient require a follow-up appointment.

There is a longer-term ambition to extend the GP Connect appointment booking capability into A&E to allow booking into Primary Care services.