Hubtastic, not

There’s a fashion sweeping GP funding schemes - gotta getta shiny new hub.  Chrome, alloy, spokes - what’s yours?  Hubtastic!

“Hub” is all over the review of PMCF wave 1, 44 mentions no less, in hallowed tones.  But let’s look at some of the numbers which squeeze into the narrative.

£45m spent.  £3.2m savings identified.

£30-£50 per available GP slot, only 75% utilised.

Dear friends, excuse my elementary maths but at a time when the NHS needs to make every penny go further, this is an abject failure.

It’s worse, because the hubs are shown to have increased inequality of access, and we’ve seen evidence that around a third of patients seen are redirected to their own GP.  This is the cost of  rework when continuity is cast aside.

The good life we enjoy in our times is founded on relentless pursuit of higher quality at lower cost.  Plainly these hub designs have given us lower quality at higher cost.  They are unsustainable.

Response to the evidence?  Manchester announces 15 hubs which will sink £5.4m.  You’ll know that supply-induced demand is the unintended consequence which dogs so many NHS intitiatives.  Nothing unintended here:  they are advertising the new supply to persuade patients to go there.  You couldn’t make it up.

Resources are needed in core general practice, where they are three to five times more productive.  We already have an out of hours service.  Fancy funding schemes are directed outside core GP, and powerful interests are shouting about them.  Three things are needed to turn this around:

  • The method to increase capacity in GP
  • The funding mechanism to reward GPs for dealing with all demand
  • Imagination, resolve and leadership to make the change.

We know the method and the new thinking:  Enabling Demand-Led General Practice

Dr Ed Diggines comments in the report on his own practice case study, “the fact that NHS does not reward increased productivity is a frustration.”  So far.  But we are building a mechanism to enable the funding to follow the patient.  By keeping it in core GP where it is most productive, everyone wins.  Intrigued?  Drop me a line.

Leadership lies with you.  Don’t just be a follower of fashion.

Dr Sara Cowell

Save the date:  we are announcing a new webinar series on the demand-led system, starting at 8-9pm on Thursday 4/2.  Unlearning the supply allocation system.

2 responses to “Hubtastic, not”

  1. Dr Sara Cowell says:

    From Dr R Sangha:
    You said the Hubs give lower quality - I simply don’t agree with this! Where there is read -write access to the medical record then where appointments are appropriately filtered into Hubs then the quality can be maintained whilst preserving the core hours practice GP’s sanity.

    In the end we all need to work together and not in silos and traditional ‘small corner shop working’….it’s time we come together and realise that the needs of society are changing and we need to change too in order to meet those needs!

    Practice Assist allows more time for practice GPs to spend with more complex patients whilst our Hub can off load some of the simpler work where patients are not needing continuity of care. Not everyone needs to be seeing the same GP for every presenting condition. Regarding inequality of access - a central telephone hub for example can provide vital access to healthcare for patients that previously might have had nothing or very little! Usually in traditionally under-doctored areas…

    • Dr Sara Cowell says:

      Agree that shared access to records is very important and should be standard for out of hours services.
      My comment in the blog about quality was related to the finding that around one third of patients are told to go and see their own GP, which is pure rework.
      Continuity is important for many consultations, around 40% according to our GP audits, but clearly not needed for everyone.
      I want to see designs which work, for service, quality and economy. I can’t comment on Practice Assist, the blog concerns the report and GP hub designs which are failing most of all on economy. Inequality of access was related to the hub attracting more of the patients at the hub practice, unsurprising but also unfair. A telephone service, or indeed online, does not affect equality for everyone who has a phone or internet. I agree that we need to be imaginative in our service design in particular in under doctored areas, but wasting money on unsustainable schemes has only made matters worse.

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