Dr Mike Warburton National Director for the National GP Access Programme Department of Health

1. Health Inequalities and GP Access Dr Mike WarburtonNational Director for the National GP AccessProgrammeDepartment of Health

2. Context NHS Reform Expanding capacity & increasing investment Waiting times- 18 weeks 1 Shifting the power Introduction of radical changes Patient Choice, PBR, PBC 2 Focus on quality outcomes and patient experience Health Inequalities and health outcomes, Quality 3

3. UK data shows better outcomes linked to more GPs per head of Population US evidence Access to freely chosen GP is assoc with better and more appropriate care and better health at lower cost- Barbara Starfield Where patients have a primary care physician they achieve a lower 5yr mortality rate High quality primary care associated with reduced racial and ethnic disparities GP Access and Inequalities

4. Inequalities and deprivation Case for change Two-fold gap remains across the country between numbers of GPs and nurses • Those areas with fewer primary care clinicians also tend to have: • Poorer health outcomes • Lower QOF scores • Closed lists • Fewer GP registrars • An ageing GP population Cambridgeshire has almost 60 WTE GPs and nurses/100k population more than Manchester and the average man can expect to live 6 years longer

5. Patient satisfaction Case for change GP Patient Survey overallshows good progress – 84% of patients satisfied with access to GP services • However: • BME patients less satisfied (Bangladeshi patients 20% less happy than white patients, sometimes even within the same practice) • 6.5 million patients unhappy with practice opening times • Younger employed people unhappy with current opening hours • Large variation between practices within PCTs

6. Practices in deprived areas perform worse than practices in affluent areas Worst performing practices are large practices in deprived areas serving a significant black and ethnic minority population Patient Satisfaction Inequalities

7. What happened as a result of the GPPS? • Alan Johnson announced 5 measures for local action to improve access to primary care: • Local PCT action plans • Publication of practice performance data (GPPS & QOF) on NHS choices to empower patients • Establishment of the National Improvement Team to support poorly performing PCTs and practices to improve access • Mayur Lakhani’s review of BME access to primary medical care • Review of the incentives for access and responsiveness in QOF • National GP Access Programme (March 2008)

8. National GP Access Programme • Drivers: • Improving health inequalities • Increasing patient satisfaction 1. Extending hours of existing practices 2. Local procurements of GP practices and health centres 3. Wider responsiveness to patient needs 50% of practices to open at times that suit the needs of their patients • Additional £250m for: • 100+ new GP practices in areas of greatest need • 152 GP-led health centres Continuing improvements in the access and responsiveness of GP services (building on the recommendations in the BME and NIT reports)

9. Support National GP Access Programme 1. Extending hours of existing practices 2. Local procurements of GP practices and health centres 3. Wider responsiveness to patient needs • Regional workshops run by NHS PCC to support implementation of the extended hours DES. • DH will support NHS PCC with a peer support process to collectively work through barriers to progress, highlight and share best practice nationally and answer FAQs as they arise. • Support package comprising • Procurement Framework • SHA embedded commercial expertise through Commercial Partnership Managers and PASA Commercial Development Managers • DH mailbox for queries • Regional procurement master classes • Support for regional bidder information days • PCC expert technical support • Combined approach of strengthening PCT commissioning and developing primary care providers • Currently discussing with SHAs/PCTs and providers the most appropriate approaches but this will include as a starting point, collating and systematically sharing existing best practice

10. North Yorkshire and York PCT -highest rates in England for under 18 alcohol specific hospital admissions and are procuring a range of additional services targeted at the younger population including sexual health and drug & alcohol services, mental health and homeless services. Kirklee's plan to locate their health centre in an area with high list sizes where patients are finding it difficult to register. Bolton PCT are incorporating a special interest practitioner service within their health centre focussing on the induction and integration of asylum seekers, refugees and economic migrants. Bradford – plan to locate the health centre in their most deprived ward with high rate of unemployment, overcrowded housing and a growing Eastern European transient population. They plan to procure additional language services within the centre to improve access for BME groups. Local needs

11. Inequalities in service provision need to be addressed- we have made a start Questions: Do we need more of the same – or different models of primary care to address different needs? As well as achieving universally excellent GP access is Health Literacy the next step in ensuring primary care is as effective as possible in reducing health inequalities In improving access generally without a specific focus on inequality, we risk widening the health inequality gap ………..Further work needed Looking Ahead

12. Any further support required? National Support Team Dr Mike Warburton Mike.warburton@dh.gsi.gov.uk Phil Walker Philip.walker@dh.gsi.gov.uk Andrew Kent Andrew.kent@dh.gsi.gov.uk Dean Merritt Dean.merrett@dh.gsi.gov.uk Kathryn Stillman-Burrell Kathryn.stillman@dh.gsi.gov.uk