Improving access to services especially primary care

Through the engagement that we have undertaken to support the development of this strategy, we have heard a lot from local people about the importance of timely and simple access to joined-up health and care services when they need them.  People have told us about the challenges and frustrations that they currently experience accessing a range of different services – in particular, the importance of access to general practice services. 

We have been honest about the challenges that we are facing as a system. Specifically, rising patient demand, financial pressures and increasing workforce shortages.  While these impact on our ability to improve access to services, we remain positive about the opportunities to deliver new and innovative methods of delivering General Practice services through face-to-face, online and telephone appointments from an increasingly varied and professional workforce.  In Coventry and Warwickshire, we are clear that the future of General Practice is to adapt and develop, to support the needs of our patients. We believe that the new structure of the NHS creates the opportunity to accelerate work already underway to deliver a much more integrated way of working, enabling partner organisations of the ICP to respond to the needs of local populations within available resources, to improve patient care, outcomes through access to services.   

From our engagement with local people, we recognise that everyone wishes to access services in a different way, and we need to adapt to this choice. Many of these new routes into General Practice services were driven by our response to the Covid-19 pandemic. Local Providers of health and care services, including GP practices, rapidly adopted a range of new technologies and, as a result, digital access to services became much more widespread in our system.  Whilst we recognise that accessing services through digital channels does not suit everyone, our local vision is to harness digital technology to enable local people to access information, support and care easily and confidently. 

Key to our ability to provide the primary health care services that our patients need, will be the workforce.  We have already seen significant increases in certain roles, such as pharmacists, physiotherapists, social prescribers and paramedics, who have delivered enormous value to patients as part of the wider multi-disciplinary team.  Key over the coming months and years will be to increase these roles alongside a clear plan to support increased numbers of General Practitioners and the wider nursing team. 

If we are successful, we expect to see increased patient satisfaction relating to shared decision making and access to services, including general practice services.
 

What are we doing already?  

Every day in Coventry and Warwickshire tens of thousands of people access services through our 120 local GP practices and 19 Primary Care Networks (‘PCNs’).

While local GP practices are delivering more appointments than ever before and national GP Patient Survey results continue to demonstrate that they are performing better than the national average across a range of key areas, we also hear from some local people about the difficulties that they experience accessing their local GP practice.  We are already using the data available to us, including data relating to GP appointment activity, to understand and tackle variation, and this will continue to be an area of focus for us over the coming years.  

As we have set out, we believe that integrated working will be central to improving access. Dr Claire Fuller’s recent landmark report, strongly reinforces the direction of travel that we have already set out on to transform our local out of hospital system in Coventry and Warwickshire through greater integration between primary, community and secondary care, social care and the Voluntary Community and Social Enterprise sector. Through our local out of hospital contracts, providers of services are working together to redesign care pathways in a more joined up way which supports our most vulnerable and complex patients to be able to remain safely at home through access to proactive care in the community.   
Critical to our success in building a more integrated health and care system will be for us to continue to sustain and nurture the development of our 19 local PCNs, which bring together groups of GP practices to work together, alongside other NHS service providers, to develop services around the needs of local communities. These PCNs will continue to be the building blocks for wider out of hospital service integration.   

Local PCNs have engaged with their local populations to develop new ‘enhanced access’ services which are extending access to general practice services during evenings and at weekends across Coventry and Warwickshire.  They have also continued to expand the provision of social prescribing, supporting people to self-care and to access different sources of support in their communities, from creative activities such as art and singing to advice on housing and employment issues. 

The delegation of responsibility for commissioning pharmacy, optometry and dental services from NHS England to the ICB in April 2023 offers an opportunity to strengthen the links across the different primary care contractor groups and to further drive integration across the primary care sector. 

We have also been working on enhancing the community diagnostic capability and resources across the system to improve access to diagnosis services following the Sir Mike Richard’s review of NHS diagnostic capacity. Capital investment in community diagnostics for Coventry and Warwickshire to support this work has been secured. 

 
What will change in our ways of working? 

In order to improve access to services and especially general practice services, we will work towards:

• increased collaborative working across partner organisations of the ICP, driving increasingly integrated models of care/service delivery, including a transformed model of integrated out of hospital care 
• well supported PCNs operating with increasing maturity 
• resilient General Practices delivering accessible, personalised, high quality care 
• increased diagnostic capability and capacity across the workforce and improved access to community diagnostic services 
• improved and increased digital interoperability between primary and secondary care.  

 

What actions are we prioritising?  

• Delivering the funding guarantee for primary and community care, and continuing to maximise use of available primary care development funding.
• Continuing to support PCN development and delivery of the national PCN services set out in Network Contract Directed Enhanced Service.  
• Development of the Primary Care Collaborative – a ‘guiding coalition’ of leaders from within the general practice sector.
• Developing our local Fuller Stocktake implementation programme centred on the action areas identified in the Fuller Stocktake Framework for Action.
• Working with our primary care collaborative to refresh our Primary Care Strategy in the context of the Integrated Care Strategy and the Fuller Stocktake. To ensure that our plans meet the needs of practices, PCNs and patients. 
• Working with our local Out of Hospital service providers to better integrate services across primary, community and secondary care, taking a more proactive and preventative approach to health care.
• Establishment of three community diagnostic hubs across Coventry and Warwickshire.