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Will Whittaker and Natalie Ross: Extending access to primary healthcare: th...

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Booth Street East

Manchester

M13 9SS

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Extending access to primary healthcare: the roll-out of 7-day services in Greater Manchester

Natalie Ross, Will Whittaker, Damian Hodgson, Pauline Nelson, Laura Anselmi, Caroline O’Donnell and Katy Rothwell

Since 2013, extended access to general practice in England has been a national health policy priority, with the GP Access Fund (GPAF) and General Practice Forward View (GPFV) providing financial support to CCGs for expanding primary care provision. In Greater Manchester (GM), the recent roll-out of 7-day access arrangements across 7 CCG areas has been evaluated by NIHR CLAHRC GM. Areas submitted plans for 7-day primary care provision to NHS England in mid-2015, to run throughout 2016.

The research team carried out a mixed methods evaluation to answer the following research questions:

(a) How has 7-day access been implemented in GM?

(b) How have patients responded to the 7-day access service?

18 semi-structured interviews were carried out with NHS commissioners and providers to determine organisational and operational issues arising in the implementation of 7-day access, and how areas addressed them. In addition, 7-day activity and appointment data from each of the CCG areas was collected to provide an assessment of the demand and uptake of the service.

The evaluation found substantial variation in the provision of 7 day access across GM in terms of the number, and type, of ‘hubs’, extent of hours, and range of services provided. Some areas were operating a full suite of services and struggling to cope with demand, whilst others were struggling to get the service off the ground. The number of hubs in each of the areas ranged from one to four, whilst the type of estate used ranged from small private practices to brand new primary care services centres. The demographics showed that hub-based practices dominated use. In addition, extended appointment users were predominantly female, and disproportionately younger than core hour users (measured via the GP Patient Survey). With regards to uptake, whilst initially it was highest through the working week and lowest on a Sunday, uptake improved throughout the period (including on a Sunday).

The evaluation suggests that different implementation strategies reflect different contexts and also different conceptions of 7-day access. Extended appointments appear to be meeting a demand comprised of working aged adults during the week, and children at weekends. Uptake trends suggest assimilation is important, whilst hub dominance affects the extent of service provision. In light of these findings, the delivery of a 7-day service needs to take into account the context of local populations, focus on raising awareness of access and supporting engagement with the service.


Light luncheon refreshment will be provided at the beginning of this seminar.


Dr William Whittaker

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Lecturer of Health Economics at The University of Manchester

Will Whittaker is a Senior Lecturer in Health Economics at the University of Manchester. He completed his PhD in Economics in 2008. He was awarded an NIHR/MRC/ESRC Early Career Postdoctoral Fellowship in Health Economics in 2010 and is a panel member on the North West NIHR Research for Patient Benefit funding stream. Will created and directs an MSc programme that aims to bring economists with strong econometric training into health.

His research covers a wide breadth of areas including: work sickness and incapacity; inequalities in access to dental services; determining equitable needs-based fair shares formulae for English health care budgets; and access to primary care services. He is currently evaluating 7-day primary care initiatives which involve evaluating a local (Greater Manchester) pilot scheme and advising the evaluators of the national GP Access Fund scheme. His focus has been on investigating impacts on secondary care and identifying implications for access and inequalities in access to primary care.

Will is also part of the team evaluating the National Diabetes Prevention Programme. He leads on a work package that seeks to investigate the effects of the programme on inequalities in diabetes, with a particular focus on the role of access to the service.


Dr Natalie Ross

Image result for nathalie ross university of manchester

Research Associate at The University of Manchester

Natalie Ross is a Research Associate for the Organising Healthcare Programme within the Alliance Manchester Business School. Her current research examines the roll-out of 7-day access to primary care in Greater Manchester, and wider Greater Manchester NHS Workforce issues.

Prior to healthcare research, Natalie worked in environmental policy making and parliamentary practice for several years, completing her PhD in Human Geography in 2013 in collaboration with the Scottish Government. Where complexity presents a challenge to policy interventions, Natalie has specialised in qualitative ethnographic methods, attuned to people’s values and experiences, to tackle over-simplifications taking place within public sector organisations.

Her current research interests focus on the sustainability and resilience of the research process, and putting findings into practice. She is currently developing theories and methods within the realm of ‘careful’ and emotional geographies that enable the building of long-term relationships and networks that can continue beyond any personal appointments within the research team or public organisations. She uses a grounded theory approach to analysis to reveal existing social relations, coupled with theories of ‘community-making’ to identify areas of overlap and difference and facilitate integration of key players.


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Booth Street East

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M13 9SS

United Kingdom

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