Hundreds of people in St Helens are failing to attend out-of-hours GP appointments

In October 2018 St Helens CCG commissioned the Improved Access service to help meet the growing demand on the borough’s GP practices.

Additional GP evening and weekend appointments are available in each of the four Primary Care Networks across St Helens.

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These appointments are available 365 days a year and are intended to cover routine appointments rather than being an out of hours urgent care scheme.

Patients failing to attend these meetings has been a particular problem in this service since it launched, according to a new report from the CCG.

In October, there were 1,000 appointments available on the Improved Access service. Of that total, 171 people did not attend.

This meant the DNA (did not attend) rate was the highest since the service began in October 2018, at 18 per cent. However, the service also had its highest utilisation rate in October (93 per cent).

Since the Improved Access service was launched, up until October 2019, there were 1,309 appointments where someone did not attend.

The data was revealed in a report produced by the CCG at the request of St Helens Council’s health and adult social care overview and scrutiny panel.

Julie Ashurst, St Helens CCG’s director of commissioning, primary care and transformation, told the panel on Monday that the Improved Access scheme is a “great service” to support capacity issues within primary care.

However, she revealed that many of these appointments over the weekend are still not being used.

The CCG recently investigated to see whether there was a link between Improved Access attendances, A&E and St Helens’ Urgent Treatment Centre.

Ms Ashurst said the CCG discovered a “very clear” correlation between the Urgent Treatment Centre and A&E.

The CCG found attendances at Whiston Hospital’s emergency department spiked when fewer people attended the Urgent Treatment Centre.

“We found it harder to draw a link between primary care and A&E,” she said.

“What we did find is, on Saturdays and Sundays we regular have unused Improved Access slots.

“And on Mondays we regularly have very, very high attendances at A&E.

“So, it could be – and it is only anecdotal – but it could be that people are waiting to go to A&E.”

Currently there are 34 practices within four primary care networks in St Helens, covering North, South, Central and Newton/Haydock.

The DNA rate for all GP appointments in St Helens averages at 6 per cent, which is higher than the national average.

This varies between practices, from 1.7 per cent to more than 10 per cent in some practices.

Many GP practices have invested in text reminder messages to try to ensure patients remember their appointments and cancel them if they no longer need to attend, which has improved the borough’s DNA rate.

Speaking to councillors, Ms Ashurst said GP workforce and availability is “by far” the biggest challenge within primary care.

In St Helens, 57 per cent of the workforce are over 45 and 27 per cent are over 55, according to the council report.

The borough has also lost 16 per cent of its GPs since 2016.

Ms Ashurst said: “That’s a national problem, that is not local to St Helens, but I think the problem that is local to St Helens is perhaps our ageing workforce of our GPs.

“We are coming to a point where we have to do something about this now otherwise the appointments will get worse.

“So that has been recognised nationally and newer ways of working are happening because we simply don’t have enough GPs.”

To address the workforce issue, St Helens CCG worked with the British Medical Journal to develop a campaign to attract and recruit more GPs.

However, only one GP has been appointment as a result of this campaign.

The report says this was largely due to the fact that the number of GPs nationally is falling and there are not enough GPs to cover existing GP vacancies.

The CCG also warns in the report that public expectation to see a GP in all circumstances is “no longer realistic”.

It says that it is “essential” the borough’s residents understand this change in skill mix in primary care as it will become “increasingly common” to see an alternative practitioner in future.

Therefore, the CCG will look to engage with the public to ensure this message is communicated to residents.

Conservative councillor Linda Mussell, a retired primary care advanced practitioner, said the public perception of GPs is outdated.

Conservative councillor Linda Mussell

Cllr Mussell said: “People, and I’m using the population as a whole, still think of GPs as they did in 1948, and we’re in 2020.

“Things have moved on.”

To help ease the pressures on A&E and GPs, the CCG recently launched a publicity campaign to ensure the public are aware of alternative NHS choices.

And in November, training was given to more than 200 receptionists around signposting to other services.

Ms Ashurst said the CCG is working on several new ways of working, such as increased digital offerings and a social prescriber model, with the aim of freeing up GPs for those who need one most.

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The CCG is also aiming to introduce Practice Nurses into the Improved Access service from this month.

This will allow GP Practices to book patients in for a wider range of conditions outside of normal practice hours.

Ms Ashurst said patients will begin to see the full impact of these new models over the next four years.