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

Nuffield Trust | May 2019 | Improving access out of hours: Evaluation of extended-hours primary care access hubs

The Nuffield Trust was commissioned by Barking, Havering and Redbridge CCGs to evaluate the impact of access programmes in these boroughs.

The schemes aimed to improve the quality of primary care services and to improve patients’ experience and outcomes over a two-year period.


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.

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.

Full details from the Nuffield Trust


Directly commissioned services reporting requirements

NHS England | May 2019 | Directly commissioned services reporting requirements

The introduction of a set of four information standards for contract monitoring: Aggregate Contract Monitoring (ACM), Patient Level Contract Monitoring (PLCM), Drugs Patient Level Contract Monitoring (DrPLCM) and Devices Patient Level Contract Monitoring (DePLCM) are the file formats by which providers must report their healthcare activities commissioned by NHS England during 2019/20.

The purpose of these standards is to enable the interchange, in a uniform format, of monthly contract monitoring data between commissioners and providers of healthcare. This ensures that contract monitoring and reporting is consistent and comparable across all commissioning organisations and their footprints.

The user guidance document for each of the four contract monitoring data sets provides instructions to providers with regards to their population and submission.

Further information is available from NHS England 

Procedures for CCGs merging or changing constitution

NHS England has issued policy and procedures to be followed by clinical commissioning groups (CCGs) and NHS England in the circumstances of a CCG wishing to apply to make changes to its constitution or to dissolve or two or more CCGs wishing to apply to merge 

This document has been revised from the previous version (November 2016) following publication of the NHS Long Term Plan in January 2019. The Long Term Plan describes how the commissioning system will continue to evolve and sets out the intention that by April 2021 all of England will be covered by an Integrated Care System, involving a CCG or CCGs working together with partners to ensure a streamlined and single set of commissioning decisions at system level.

Some CCGs will want to merge to facilitate this streamlined and integrated commissioning approach, and those considering merger are encouraged to discuss their plans with their regional team, which will provide further advice and guidance.

Full document: Procedures for clinical commissioning groups to apply for constitution  change, merger or dissolution | NHS England and NHS Improvement

Digital leaders in primary care

A new online forum for digital leaders in primary care will be launching soon, formed by NHS England’s Primary Care Digital Transformation team.


The aim is to build a national network of chief clinical information officers, clinical information officers, chief nursing information officers and clinicians with a digital/IT portfolio within their CCG role. The forum will be used to communicate key messages from NHS England’s digital programmes including the GP IT Operating Model, receive feedback, create discussion forums, promote events, workshops, training and briefing sessions for its members and share local successes and examples of good practice. Register your interest by emailing

Improving the effectiveness of musculoskeletal health

Board Assurance Prompt: Improving the effectiveness of musculoskeletal health for NHS Commissioners | Good Governance Institute | April 2019


Demand for Musculoskeletal (MSK) services is rising as the UK’s population ages and grows.  MSK conditions now affect 1 in 4 of the adult population. They are the biggest cause of the growing burden of disability in the UK, and cost the NHS £5 billion each year. With capacity and resource already stretched across the NHS, this will have significant finance and performance implications for NHS commissioners, especially if local pathways are not configured optimally.

This briefing, targeted at NHS commissioners, is intended to support organisations plan and manage appropriate and effective orthopaedics, diagnostics, rheumatology, pain and MSK services to their local population. In particular, it aims to help colleagues with no clinical background understand key healthcare issues relating to MSK.

Full briefing: Improving the effectiveness of musculoskeletal health for NHS commissioners

Public service commissioning

This report provides an overview of public service commissioning in England | Reform

This report explains how public services are delivered and by who. It identifies several key areas where weak or under performing elements in the commissioning cycle have led to failings in the procurement of public services and suggests potential solutions to some of these challenges.

Full document: Please Procure Responsibly. The state of public service commissioning