GP Provider Support Unit, Birmingham and Solihull

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The Right Access First Time programme was created to address primary care leaders’ desire to improve access and manage workload in the most clinically appropriate ways, helping practices take control while also meeting their contractual requirements.

The programme arose from discussions between the GP Partnership Board and the ICB, both of whom recognised a new approach was required to improving access which was not solely defined by the national contract and which moved away from the narrow focus of previous access initiatives.

The RAFT programme was formed with input from BSol's PCN directors and managers

An initial design event in April 2023 brought together clinical directors and managers from all of BSol’s PCNs to set the principles and aims of the programme, and to begin building the menu of ‘access actions’ that they recommended. Following that, practice engagement events in each locality are helping to identify additional ideas, and confirm local priorities for action.

Principles

The programme is based on principles established in April 2023 by the primary care network directors and managers in BSol:

  • access is at the heart of good care for patients and a better working life for GPs and practices
  • improving access will take action across the whole system – the ICB is stepping up work to increase capacity and reduce inappropriate demand on general practice … and there are some actions which only practices themselves can take
  • we want to make changes that connect patients with the right person at the right time in the right place for the right care – and do it first time, without patients being ‘bounced’ between members of the practice team or having to call back repeatedly
  • we will bring together different streams of funding for improving access, to make a coherent programme of clinically led improvement at practice level
  • we ask the new Provider Support Unit to take a joined-up approach to supporting practical changes that will help patients and practices 

Programme approach

RAFT has been planned with the following principles:

  • Sector-led. The impetus and ideas behind the programme have come from BSol’s primary care leadership.
  • Patient-focused. The starting point and the aims have been framed around providing the most appropriate access systems for patients, recgonising their varied needs and the importance of moving away from one-size-fits-all approaches.
  • Working smarter. Primary care leaders have been clear that access cannot be improved by working harder or simply waiting for capacity to increase. The ‘access actions’ are therefore solutions which will release clinical time as well as improving access for patients.
  • Accelerated design. There is both a need and an opportunity to achieve improvement faster than is often feasible. Firstly, the new national contract changes require rapid action by practices, PCNs and ICBs. Secondly, we have the opportunity to use the extensive knowledge practices already have about the current situation along with the growing experience of some practices in implementing new solutions for access. The design stages will therefore draw on real-world examples as well as improvement science frameworks for reliable and efficient process design.
  • Parallel piloting. The use of the ‘Improvement Collaborative‘ method for planning implementing change will allow for several different sets of questions and options to be tested simultaneously in each locality, through parallel piloting in different practices. This will allow providers to arrive at the most effective embedding approaches more quickly.
  • Learn-while-doing. One of the traditional challenges with primary care service redesign is the low level of leadership and improvement capabilities in the sector. RAFT will address this by providing improvement facilitation for each locality collaborative, to ensure their work draws on appropriate expertise. Additionally, just-in-time learning will be provided in the collaboratives about key improvement tools that will be used, such as reliable design, the Model for Improvement and PDSA, and measurement for improvement. These activities will be accompanied by the launch of a new capability-building programme run by the PSU, providing a range of opportunities for clinical leaders and managers to develop their effectiveness as change leaders.
  • PSU-served. Supporting RAFT is the PSU’s chief objective. It is also the first opportunity to demonstrate our new approach, of responding flexibly to the invitation from practices rather than following a system-set agenda.

Methodologies

We are taking a pragmatic large scale change approach to the delivery of the programme. At higher levels this draws on the NHS Change Model and the NHS Large Scale Change model. At the level of participating practices in their locality, we are facilitating Improvement Collaboratives for accelerated implementation of change. These are recommended in the latest NHS England guidance on improving access, which refers to them as ‘improvement communities’.