Improving access out of hours: Evaluation of extended-hours primary care access hubs

Could schemes aiming to increase the availability of primary care health care access out of hours improve the overall quality of services and patient experience in outer east London? The Nuffield Trust was commissioned by Barking, Havering and Redbridge CCGs to evaluate the impact of access programmes in these boroughs.

In 2014, the Barking and Dagenham, Havering and Redbridge (BHR) Clinical Commissioning Groups (CCGs) in outer east London set up two schemes framed under the ‘Better Access, Better Care, Better Lives’ programme and partially funded by the Prime Minister’s Challenge Fund.

The schemes involved:

  • improving public access to primary care by providing additional capacity outside of core hours
  • the development of a new integrated care hub for the management of people with complex care needs.

BHR CCGs commissioned the Nuffield Trust to evaluate both schemes and to consider their impact on patients and carers, staff and the wider health system. This report covers the first of the two schemes – the primary care access programme. It adopts a mixed-methods approach, including both quantitative and qualitative components, to assess whether the services improved service availability, patient access and patient outcomes. It also makes a broad assessment of cost implications for commissioners. 

A report on the evaluation of the second of these schemes, the integrated care hub, was published in 2018.

Key findings

  • Most of the patients we interviewed told us that they had chosen to attend the hubs because they found it difficult to attend in-hours primary care services. Others said that they had wanted a speedy clinical assessment for themselves or their children.
  • Patients particularly liked the appointment-based system at the hubs and this was what they highlighted when distinguishing between the hubs and other services such as walk-in centres and A&E departments.
  • Since the hubs opened, there has been an increase in the use of A&E services across the boroughs. However, during our research the size of this increase appeared to be associated with hub attendance in that it was significantly lower in areas where hub attendance was highest by approximately 4.5%. This suggests that the presence of the hubs may have been diverting some people who would otherwise choose to attend A&E, or who may have been sent to A&E by NHS 111, away from this service.
  • However, from a commissioning perspective, such reductions in A&E attendance would not be enough to offset the local cost of providing the hub service.
  • During the study, a call centre had been introduced to improve the appointment booking process. By 2016, between 80% and 90% of patients attending the hubs were recorded as self-referrals, presumably because they had used the call centre. The number of referrals from NHS 111 had remained more stable and generally not increased as new hubs opened.
  • The hubs had adapted to lower demand on Sundays by reducing opening hours and staffing, thus ensuring that Sunday usage rates were comparable to usage rates on other days of the week.
  • Some staff working at the hubs raised concerns about their lack of access to patients’ medical records and their inability to refer patients on for further treatment. Both these areas require effective systems to be in place to avoid the potential of increased clinical risk.
  • Survey responses from staff working at the hubs revealed a largely positive attitude towards working at the hubs, with 59% of staff saying that working at the hubs was better than their other or previous work.
  • It is possible that the hub scheme may have had an effect on the locum market in the area: some staff not working at the hubs suggested that higher locum rates being paid to hub staff might reduce the availability of locums for in-hours work.

Suggested citation

Crump H, Arora S, Sherlaw-Johnson C, Holder H, Davies A and Lombardo S (2019) Improving access out of hours: Evaluation of extended-hours primary care access hubs. Research report, Nuffield Trust