coercive, unclear, unsafe and no consultation

North West London Integrated Care Board (ICB) has been attempting to enforce a new model of care for Same Day Access in primary care, originally threatening to remove a large percentage of funding from any Doctors Surgeries who refuse to cooperate.

The ICB plan – which remains in place, albeit now delayed – would redirect “acute non-complex cases” through a uniform imposed Surgery phone system to a Same Day Access hub staffed by non-clinical care coordinators and additional roles clinical staff (clinical pharmacists, physician associates and paramedics) overseen by a GP clinical supervisor.

An unfinished pilot programme of ten PCN sites has been supported by management consultants KPMG to try out parts of the Same Day Access model over the past year but no evidence has been provided of evaluation of patient, practice or system outcomes at these pilot sites, nor has there been any recording of this.

The case for these changes being imposed by the ICB is unsupported by relevant data on access and patient satisfaction from many NWL practices and patients, and does not reflect explicit national policy on primary care access.

The ICB has deliberately avoided public and primary care professional scrutiny in preparing its plans. For example, at a two-hour engagement event held by the ICB and KPMG with NWL PCN Clinical Directors on 14th February 2024, all attendees were muted and there were no opportunities for verbal interaction. At that meeting the clinical leader with responsibility for the new Same Day Access model stated that public consultation was ‘about to begin’.

Communications from NWL ICB have provided further confusion. For example, on 22nd February 2024 a news message on NWL ICS website in reply to ‘Will I still be able to see my GP?’ states ‘Of course. The aim of this programme is to make access to GP appointments easier for those who need them’, despite the model explicitly stating that all acute, non-complex patients will be directed by phone though to a Same Day Access Hub and therefore will not have a choice to see their own GP.

Concerns have been raised by patient groups, GPs locally and nationally and the London Medical Council on the risks to patient safety, clinical quality and effectiveness of care, logistics and IT functionality and workforce training and retention which have not been adequately responded to.

The day after its partial climbdown on March 5th, at an online meeting with GPs and Surgeries, the ICB could not say what action – if any – it is now going to take to review and strengthen its governance, to ensure that its approaches to managing change will be different in the future.