Improving Access in Hywel Dda
Principles for Good Access
1. Introduction
Practices are resourced under the GMS contract for the provision of General Medical Services
during the core hours of 8.00am – 6.30pm. “Delivering Investment in General Practice” (January
2004) states that normal surgery hours must be “ to the extent necessary to meet reasonable
need.”
“Reasonable need” has not been defined within Hywel Dda Health Board and therefore this has led
to a wide variety of expectations from patients and differing levels of satisfaction of the services
experienced. Whilst no single model offers the perfect solution, the intention is to implement a set
of principles of good access to which all practices should aspire to.
2. Principles of Good Access
The Principles of Good Access are split into two levels :
Foundation Principles: these are core principles which should be available from all GP practices
in order to meet the “reasonable need” of patients. The Health Board will monitor these standards
on an ongoing basis.
Positive Principles: these are principles that are considered to be best practice in order to ensure
that the practice is listening to their patients, adjusting access based on evidenced patient need
and providing the contractually defined essential service,
“at such times, within core hours, as are appropriate to meet the reasonable needs of
its patients, and to have in place arrangements for its patients to access such services
throughout the core hours in case of emergency”
The criteria identified will be used by the Health Board where it identifies that the Practice may
NOT be meeting the reasonable needs of patients, this may be through LHB review, patient
complaint both informal or formal, concerns raised by the CHC or through questionnaires by
patient groups. The criteria are not part of the GMS contract however, they have been agreed as
good principles that practices should aspire to and will form the basis of access discussions with
practices.
The LHB monitoring criteria will be used as a basis for Practices wishing to apply for the Extended
Hours LES.
3. Definition of the Principles of Good Access
Foundation Principles are part of what is considered to be good access within the existing GMS
contract. There is no additional funding for achieving this level as it is expected that all practices
will deliver to this standard and that all patients can expect this level of access. Practices are not
expected to make any submission of evidence separately (unless an application for the Extended
Hours LES is being made) to the LHB, the criteria are included for information and transparency.
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Principle
Appointment systems should be easy to
understand and use by patients: Patients
should be able to book appointments at least by
phone and at the reception desk. Consideration
should be given to alternative forms of booking
e.g. My Health On Line etc. Where a practice
offers part of their service as “open access”,
patients should be appropriately guided in how
to access the doctors and nurses in both
emergencies and for routine treatment.
Positive call handling for appointment
requests:
Practices should deal with
appointment requests in a professional manner
in one call.
Answering the phone in a timely manner:
When phoning the practice, patients should be
able to speak to a person on the phone within a
reasonable timeframe without incurring undue
personal expense through the practice use of
higher-rate telephone numbers.
Accessible telephone advice or triage:
Patients should be able to EITHER access:
• telephone advice OR,
• telephone triage / clinical assessment from a
suitably qualified clinician
Telephone advice and triage can be considered
like an appointment which may be booked same
day or in advance.
Standard Opening Hours: The practice should
be open for a minimum of 5 mornings and 4
afternoons per week.
Prioritising access and response for
clinically urgent patients:
The practice
ensures all patients expressing an urgent need
for an appointment receive advice or treatment
from an appropriate clinician within 24 hours.
LHB Monitoring Criteria
Practice will publicise its appointment booking
policy in it’s practice booklet and website.
Report on significant events and/or review of
patient complaints, both internal (made directly
to the practice) and external (made to the LHB
or CHC), every year (EDU001W).
Health Board staff will monitor telephone access
on a monthly basis and record the amount of
time it takes to connect to receptionist. This
information will be shared with practices and
included on the GMS dashboard.
Practice will publicise its telephone advice policy
in practice booklet and on website.
Annual Contractual Return includes a statement
on telephone access.
Annual Contractual Return includes a statement
on opening hours.
Practice will publicise its urgent access policy in
practice booklet and on website.
Practice will publicise the range of clinicians
within the practice, including what they can and
cannot offer patients in the practice booklet and
on website.
Positive Principles are recognised as being part of delivering excellence in access to patients
within core GMS contractual hours. It is expected that all practices in Hywel Dda would strive to
deliver this level of service for their patients.
The Health Board will monitor delivery against these standards through the Annual Contract Return
and will use these to investigate where there are concerns that access may NOT be meeting the
reasonable needs of patients. Practices are not expected to make any submission of evidence
separately (unless an application for the Extended Hours LES is being made) to the LHB, the
criteria are included for information and transparency.
Principle
LHB Monitoring Criteria
Open to patients throughout core hours: Annual Contractual Return includes a statement
Practices should aim for doors and telephones to on opening hours.
be open for patient enquiries throughout core
hours* for a minimum of 47.5 hours per week.
*There are 52.5 core hours per week during which
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the Practice is contractually responsible for the
care of their patients.
Responsive to patient need, feedback and Annual
capacity,
demand
and
patient
experience: Each GP practice is different and need/experience audit with action plan.
therefore the model of access should meet the
needs of the patients specific to the practice.
Examples of patient surveys and capacity &
demand mapping tools are available on request.
Practices should regularly monitor their capacity,
demand and patient views on access and The patient survey can either be :
services. Adjustments to access would then be • GPAQ3, or
made as appropriate.
• Approved by LHB before use IF it will be
used to evidence patient demand for
extended hours.
Examples of external support for appointment
and access redesign are available.
Practices Patient literature in waiting room.
education
their local
consistent
Positive about Patient Education:
support the Choose Well patient
campaign or equivalent and work with
community pharmacies to deliver a
local message.
Appointments available throughout the Core Annual Contractual Return includes a statement
Hours: Practice should offer late appointments to on appointment times to be updated throughout
meet the needs of patients who find it difficult to the year as changes are implemented.
attend earlier in the day – GP and / or appropriate
clinician.
Appointments available after 5.00pm (for at least
30 mins) for at least 2 days per week.
4. Service Improvement Fund
The Health Board recognise that there is a significant amount of very good access across Hywel
Dda. It is also recognised that in some practices patient experience is less positive or the Practice
has concerns about how to manage workload and sustainability.
Funding Criteria : In order to positively enable practices to make changes, a non-recurrent
improvement grant fund will be made available. Bids can be made for :
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Part funding to support external agencies specialising in improving GP Access in order to
deliver the Positive Principles or develop new innovative models of access
Part funding of external management costs for work within the practice to deliver the Positive
Principles
Part funding of training & development costs to build new skills within the practice team or at a
locality/community level
Pump-priming to support the development of Patient Participation Groups with the initial
purpose of engaging patients in co-designing access
Funding will not be available :
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The full cost of improvement work
Hardware, software or telephone systems – for which an IT Business Case (if applicable)
should be made
Estates refurbishment or development – for which a Premises Improvement Grant application
should be made
Management or clinical team from the existing workforce
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The Health Board can provide information on agencies or Practice Managers who can offer
support services, or Practices can seek their own support.
Application Process : Applications to the fund should be made in writing, to the Head of Primary
Care no later than the 1st March for the following financial year. Applications can take any written
form but must include the following information :
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What the funding will be used for and how much the cost of the services are – specific itemised
costs will be required.
The level of funding sought (normally no more than 70%).
The outcomes sought e.g. redesign of access / workforce / increasing skills & knowledge in
service redesign etc
The timeframe for delivery.
Applications for funding can be made by an individual practice or by a group of practices working
together, the application should make it clear who is submitting the bid and the named contact for
the proposal.
It is expected that most bids will not exceed £2500 per practice but can be for any amount up to
this level. The Practice or cluster needs to be confident that it can spend the funding by the end of
the financial year and must submit invoices against which payment will be made.
Prioritisation Criteria : There is a limited fund available to support applications and this will be
dependent year on year by the number of applications prioritised to deliver the Extended Hours
LES. The prioritisation of bids is therefore critical and the following criteria will be used :
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Positive Principles : Practices who do not currently achieve the Positive Principles and
whose application will enable them to robustly do so (up to10 points).
Clusters & Networks : Clusters of Practices who, by working together, are seeking to
creatively improve the access of whole communities to improved GMS access (up to 10
points).
Sustainable Workforce : Practices who are seeking support to significantly develop the skill
mix of the practice to better reflect the needs of the patients and address workforce concerns
(up to 10 points).
Innovation : Practices with a good track record of access who are seeking to test new
innovative models for further improving patient experience (up to 5 points).
Patient Voice : Practices who are seeking in improve their patient engagement (up to 5
points).
Outcome Focus : Clear improvement outcomes are identified (up to 10 points).
Points will be awarded up to a maximum of 50 and as many applications as possible will be funded
in prioritised order. A panel including the Head of Primary Care, Associate Medical Director of
Primary Care, Head of Finance and the Primary Care Manager – GMS will be convened to agree
the prioritised bids.
Practices can expect a response no later than 30 days after the closing date. Should applications
not be successful, an explanation will be provided by the LHB however there is no appeal process.
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