The scale and weight of GP antagonism towards plans in North West London  to roll out a system of “same day access hubs” that would make minimal use of GPs (see Lowdown February 15) has forced the Integrated Care Board (ICB) into a limited retreat.

A letter to GPs from ‘NW London Primary Care’  dated February 19 sets out to “explain and reframe some of the language that we have been using,” and admits:

“We now appreciate that we have not explained clearly enough what our intention is around our aspiration to support same day care for patients in NW London. As a result we acknowledge that many myths have arisen…”

The letter goes on to insist: “We would never ask colleagues to do something that we felt was unsafe or unachievable.” But of course the problem was that whatever the primary care bosses may have thought, many NW London GPs believe what they were being asked to do by the ICB is unsafe and unachievable, and so do patient groups.

NW London Primary Care admits the scale of the backlash against their plans and the way they were being rolled out:

“We have listened to you, our patients and wider colleagues. We are very sorry that the way the programme has been perceived so far has led to confusion anxiety, concern and anger. This was never our intention.”

It’s obvious primary care bosses did not set out deliberately to annoy the people they need to implement the new plans. That’s not what people have been angry about.

The problem is that when people eventually saw the information the ICB had sent out, they saw a system they did not agree with, and realised it was being foisted upon them with no consultation, no prior engagement, and no account or evaluation of the experiences of the ten pilot exercises testing out the proposals.

None of these problems have been addressed or resolved.

The ICB letter adds another half-apology: “We may have, by using some phrases such as ‘target operating model’ given the impression that this is an inflexible top-down delivery of a plan. This was not our aim and we apologise.”

But NW London Primary Care goes on to make clear they are going to roll out exactly that same controversial plan anyway – just more cautiously and slowly. The breakneck 13-week schedule to impose the new system by April 1 has been abandoned, in favour of “phasing of implementation during 2024/25.”

Indeed the sting is in the tail of the ICB letter which concludes by insisting the new scheme has “been through a comprehensive sign off process relating to all of the funding … in our internal ICB processes. … We cannot now unpick the access aspects from the rest of the programme without calling into question the whole piece of work.”

In other words it’s a fait accompli, and the only question is how long it will take to push it through. And a letter sent on the same day to the North West London Local Medical Committees (representing GPs) is far less accommodating in tone. It begins by reiterating the ICB’s earlier claim that the main outline of the proposals were “agreed three years ago.”

One thing that emerges loud and clear from this controversy is that NW London GPs, whether individually or through their LMCs have not been engaged with, and are not on the same page as the ICB body trying to reorganise GP services.

It’s no surprise that, with no initiative seeking to bring them on board, busy GPs have not read through every ICB Board Paper, or noted the detail of minutes of obscure committee meetings. Nor of course have many patients or campaigners, who have no access to many of the meetings where these proposals seem to have been hatched up.

This widespread ignorance of the plans should not be taken for agreement.

For the ICB now to insist that proposals that have not been properly discussed or agreed have already been “signed off” and can’t be changed is to admit how poor their communications have been, and no doubt still are.

As if this was not bad enough, the February 19 ICB letter to the LMCs adds an Appendix that purports to answer the series of well-explained specific questions that were set out by the LMCs in their letter to the ICB on February 9. The ICB offers just two pages and 13 vague, evasive and unsatisfactory responses in answer to the LMCs’ five pages spelling out 15 detailed concerns about the plan and its potential implications.

It is most unlikely such a dismissive response will secure the result the ICB is hoping for.

But their problem has now got even worse because while there is still no proper account and evaluation of the NW London local pilot schemes to offer evidence the new system might work, there is new evidence that the ICB is committed to the wrong approach.

The GP online magazine Pulse which carries an update on the unfolding situation in NW London also reports the findings of new Cambridge University research, based on analysing data from over 10 million appointments in 381 GP practices over an 11-year period.

It concludes that – as the NW London GPs have been arguing – continuity of care increases productivity in general practice by reducing demand for GP consultations. It, therefore, advises against models of care (such as the NWL Primary Care plan) which prioritise fast access and instead urges GP practices to focus on continuity of care.

The study’s co-author Professor Stefan Scholtes from the Cambridge Judge Business School told Pulse it does not advocate separating same-day care from longer-term term care, and he said it ‘would be a mistake’ to do so ‘organisationally’, for example with ICBs running all urgent care from treatment centres.

Perhaps NW London ICB should check out the recent research before pressing further with their plans.

* It seems NW London is by no means the only ICB driving through similar plans. There is also mounting anger and concern in another ICB, (Buckinghamshire, Oxfordshire and Berkshire West (BOB)) which is promoting a plan similar to the NW London proposals, albeit this time with at least the semblance of a consultation.

As Oxfordshire Keep Our NHS Public campaigner Liz Peretz sums up: “The ICB plan also separates services for the chronically unwell, who would be covered by an area team of GPs, nurses etc. But everyone else would have to contact a ‘hub’ (covering many existing practice areas) for an appointment. This would probably not be with a GP – maybe with a Physician’s Associate or a nurse. At this stage, it is unclear whether the appointment would be near your home or far off, whether the booking would be done on line or by phone.”

Patients living within BOB ICB have a chance to comment on this before it is ‘rolled out’. The consultation finishes on February 29th – this coming Thursday. Campaigners are urging people to take the time to comment here .



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