14 Questions To Ask If Setting Up Extended Access Hubs

The new Primary Care Access Scheme provides each CCG area with an opportunity to develop plans to utilise the £6.00 per head funding to provide Extended Access using a ‘Hub’ model. There is increasing pressure to offer extended access to GP services by the October 1, 2018 deadline.

Our partners, Howbeck Healthcare, have developed successful Hubs across five CCG areas and know how to make it work and which pitfalls to avoid. They advise starting by going through the process of asking the following questions, in which their answers and experience can help you plan your Hub development.

1. How many Hubs are you planning? Most patches are basing Hubs around their 30-50K population ‘localities’, but others are using town centre locations covering bigger footprints.
2. Where are your proposed Hub sites? Consider using either community facilities or existing GP practices. Our preference is to ensure as much resource as possible is kept in General Practice.
3. How much will a Hub appointment cost? Sample sites range from £35 to over £50; there are ways of making the funding stack up with variable cost options.
4. Do you want to do 100% Hub work or do you wish to use some Practice-based work to deliver your activity target? With the activity target being 30 minutes per thousand, most commonly this is done from out of Hubs. However, we have developed an interesting ‘mixed’ model for two CCGs which increases activity and provides better Value for Money, specifically for those patients who have a preference for seeing their local GP. This is a more complex offering with more personalised service and more extended hours.
5. Who are you using to manage the Hub? You first need to ask the question of where it will be based to understand who is eligible to run it. This can vary from the community hospital or a local Practice, however, consider subcontracting the Practice to run the Hub by utilising existing Practice Managers and their staff in new roles. A bit of competitiveness can go a long way to produce more efficient outcomes.
6. What computer system do you have? Making the IT system work in a Hub so that your doctors and nurses can see the full patient record is imperative. This is easier if all Practices use the same system but it can work even if you have multiple systems, in which we can advise how.
7. What are the service gaps? What other services can you offer from the Hub i.e.  DVT, spirometry, wound care, sexual health clinics, etc? A Hub has the potential to provide a range of other services based on the needs and circumstances of the local population. Evaluate what you are doing in a Practice that might be better done in a Hub because of the extra resource available there. If additional training is required at the Practice, a Hub may be more likely to employ specialists which can remove the need for additional costs to the Practice. We have established a number of models that maximise the use of Hubs and offer patients better access to services.
8. How are you going to manage the ‘on the day’ element, particularly at weekends? The Scheme requires you to demonstrate that you are seeing a mixture of planned and urgent care appointments, specifically on Saturday/Sunday. What is your process for getting urgent appointments? Do you allow people to ring into the Hub directly? If so, you will need to have receptionists on and publicise the phone number. Another option is to work with the 111 provider to include your directory of services at the Hub so they can triage the call. We have developed a successful model using 111 to book into appointment slots on behalf of your Hub.
9. Are you able to meet the ‘activity return’ demands? There is a requirement for supplying comprehensive data, including demographic info on patients, to evaluate the success of the overall Scheme. Aggregating and supplying the data can be a very manual and time-consuming process. If you don't have the capacity to do so manually, we have developed a digital system that collects the data from the GP System and reports automatically.
10. Have you considered ways the extra activity can help sustain Primary Care? Your Hub can be used as a solution for sustainability. Once you set up the Hub, you have an opportunity to use the Hub for other things other than extended hours, such as an alternative solution for a Practice that is struggling to offer extended hours by opening the Hub earlier. We are working with a large Federation (and their LMC) to develop an offer for the Hubs to be open from 4 pm (instead of 6:30 pm during the week) to support Practices.
11. Have you got local GPs willing to work in the Hubs? How do you make it attractive for local Drs who don't want to do it? Often when you ask GPs if they want to work evenings/weekends, the answer is no as they feel they work too hard already, which anyone can appreciate. Don’t conclude what your ‘home’ GPs tell you is the final word. When a Hub is successfully set up and there are the right incentives available, people will reconsider. The aim is to get GPs to understand that in reality, it's financially favourable to work in a Hub than a traditional Out of Hours. In order to ensure there are no staffing gaps, you will also need a good Locum workforce solution such as Lantum, which will save you many headaches!
12. How are you going to do the rota management? Think about systems to take the pain away, as manual scheduling in Excel is no longer a productive option. A system such as Lantum can increase efficiency by bringing your rota online, help you quickly fill it with your local staff bank, and save you time by automating payroll, timesheets, invoicing, pensions forms and compliance.
13. Are you prepared for the requests for extra work? The basic offer may only be 30 minutes per 1000 patients, but you will be asked to deliver more over winter and holiday periods. We recommend you consider utilising an online workforce management tool solution to be able to deliver this.
14. Do you understand the indemnity issues? You’ll need different solutions based on your goal, who is paying and the circumstances of the arrangement. We often hear GPs saying that they won't be able to work in a Hub because the indemnity won't cover them and the cost is too high. This isn’t true. Firstly, the Hub needs to decide what you are doing about access to the system, if you’ll see full or partial records. Then, work out which company indemnifies you and if it's personal or Practice based. Make sure that the price you are putting together for the Hub covers the cost of indemnity for the GPs working at the Hub and make sure you communicate this to them.

Partnering with Howbeck Healthcare Ltd to setup Hubs

Formed in 2014, Howbeck has supported the creation of federations including South Cheshire and Vale Royal GP Alliance, North Staffordshire GP Federation, and more recently East Staffordshire Primary Care Partnership (covering 100+ GP Practices and a population of over 880,000 in total). Lantum and Howbeck have a shared purpose and are partnering to further propel the rigorous project management and primary care expertise when it comes to setting up primary care access Hubs.