As part of its 2013 Primary Care Commissioning Strategy, NHS England (Greater Manchester) funded a programme of six ‘demonstrator communities’ to implement and test new and innovative ways of delivering primary care services, with a key focus on increased access to general practice, integration and the use of technology. The NIHR CLAHRC Greater Manchester was commissioned to conduct an independent, academic evaluation of the demonstrator programme.
- Demonstrators offering patients additional weekday evening or weekend appointments with a GP or practice nurse made available over 50,000 appointments, 65.5% of which were booked. Uptake of weekend, and particularly Sunday, appointments was low at most sites, although there was a general trend towards increased bookings over time.
- Provision of additional weekday evening and weekend appointments appeared to be associated with a statistically-significant 3% reduction in total A&E activity, including an 8% reduction in minor A&E activity, when compared to the rest of Greater Manchester. This picture, however, was not consistent across all demonstrators.
- Surprisingly, a statistically-significant reduction in the use of out of hours and/or walk in centre services was seen at only one of the four demonstrators providing additional appointments.
- The additional appointments also had no statistically-significant impact on patient satisfaction overall.
- All demonstrators were successful in overcoming a number of substantial and complex challenges. Six core ‘enablers’ were shown to impact on the ability of each demonstrator to achieve its objectives and ambitions.
The six demonstrators were awarded a total of £4.1million by NHS England (Greater Manchester) over an 18 month period between October 2013 and March 2015. Our evaluation considers the levels of activity associated with the implemented interventions, the outcomes brought about by the demonstrators providing additional weekday evening and weekend appointments in general practice – their impact on A&E attendance, use of walk-in centres and out of hours services, and patient-reported access to, and satisfaction with, general practice services – and the processes through which the demonstrator interventions were defined, implemented and modified over time.
Damian Hodgson, Professor of Organisational Analysis at Manchester Business School and CLAHRC GM academic lead for the evaluation said: “All of the demonstrators generated important learning about the kind of critical challenges regarding service innovation and redesign which primary care is facing across Greater Manchester and nationally, and how these challenges may be met”.
Notably, our evaluation precedes that of the national £50 million Prime Minister’s Challenge Fund (first wave), which also aims to improve access to general practice and stimulate innovative ways of providing primary care services.
A more comprehensive overview of the evaluation and its findings are available in the full report and operational summary available at http://clahrc-gm.nihr.ac.uk/demonstrator.