Hub working is a hot topic across primary care right now. Here, we analyse two models for Hub working, share guidance for setting up a Hub service and talk about an exciting pilot we’re doing to facilitate Hub working.
The context of Hub working today
Opening beyond core hours isn’t a new concept in primary care. However, since October 2022, practices and Primary Care Networks (PCNs) are being asked to take a more coordinated approach to out-of-hours work in order to meet the new Enhanced Access requirements.
The Network Contract Directed Enhanced Service (DES) requires that for every 1,000 registered patients, PCNs should provide a further 60 minutes of out-of-hours appointments each week. These services should be available to all PCN patients, Monday to Friday between 6.30pm - 8.00pm, and Saturday between 9.00am - 5.00pm.
To take a PCN of 40,000 patients as an example, this would mean delivering an additional 40 hours of appointments per week to qualify for ~£300k Enhanced Access income for the network each year.
PCNs have been asked to work with both their commissioners and patients to determine the services that will be on offer, and how these will be delivered (e.g. remote vs in person). Given all patients in a PCN should be able to access appointments at these times, many PCNs are adopting Hub models in order to deliver services sustainably.
While the idea of Hub working has been around for a while, it doesn’t mean the same thing to everyone.
We need a shared definition for “Hubs”
Through our recent research, our team has noted a disparity in how practices are describing and outlining their visions for Hub working. While the exact models for Hub working vary from place to place, it’s clear that the word ‘Hub’ itself often means different things depending on who you speak to. We’ve identified two broad ways that PCNs are defining Hubs and how these underpin their models for Hub working:
1. Hubs as outlets
In this model, Hubs are set up as additional care settings that can serve patients from multiple practices. Most often, Hubs are used to manage patients out-of-hours, although many Hubs operate in-hours as well. It is common for practices to use Hubs to deliver specific services at scale for large populations of patients.
When it comes to out-of-hours work, PCNs tell us that locating services at dedicated sites has clear benefits. It enables them to sustainably deliver high quality care that meets the needs of their patient populations, while delivering on the Enhanced Access requirements.
Many PCNs are also using Hubs to deliver specific services, both in and out-of-hours (e.g. spirometry, physiotherapy, and phlebotomy). PCNs are finding that they can deliver high quality services at scale, while also utilising different types of healthcare professionals (including roles listed in the Additional Roles Reimbursement Scheme). By taking on this responsibility, Hubs can help practices in their network better manage their workload and remove the need for all services to be available at all sites.
2. Hubs as coordinators
While the first approach positions Hubs as additional care settings - or ‘outlets’ - the second positions Hubs as ‘coordinators’ i.e. a central triage or “front-door” to multiple practices. In the latter case, the teams working at these Hubs vary in structure, but often consist of both administrative and clinical staff who collectively manage inbound phone calls and online consultations from patients. ‘Coordinator’ Hubs are often able to resolve administrative queries, manage simple clinical presentations, and book onward appointments at practices.
PCNs that adopt this model advocate its collaborativeness. They maintain that, by having one team managing the administrative and triage work, they can (1) reduce workload for their practices, (2) ensure appointments go to the patients that need them most, and (3) reduce variability across sites.
While this model can help networks deliver high quality, efficient care, we’ve seen higher adoption of the ‘outlet’ model because it more directly supports Enhanced Access.
How to set up a Hub service
From both conversations across primary care and our recent research, we’ve seen that the following actions are often vital to effectively setting up a Hub service:
1. Agree on a model:
Decide which Hub model suits your network’s needs. Bear in mind that establishing an ‘outlet’ Hub can help deliver Enhanced Access and scale specific services, while a ‘coordinator’ Hub can help you scale administrative tasks and standardise triage.
Clarify the operating hours, the sites you’ll use and the patient population that the Hub will serve.
Work out the right team to staff the service - we’ve seen PCNs use a broad range of professionals, but it all depends on the service you’re offering.
2. Use the right technology:
Identify the technology you’re likely to need - ‘coordinator’ Hubs may want to use an online consultation solution like Accurx Patient Triage, while ‘outlet’ Hubs often use Hub versions of their usual Electronic Medical Record, so they can manage patients from different practices.
3. Stay connected:
Make sure your patients are kept up to date of service changes by communicating via your website, practice notices, email/SMS, and automated phone responses.
Gather feedback from your patients, and track performance data. That way, you can continually refine your model so it works for your patients and your network.
How can Accurx support Hub working?
At Accurx, we’re developing all our software with Hub working in mind. The thinking is that this will make it simple for users to switch between organisations and share work with one another in Accurx.
We’ve recently developed Hub functionality for our online consultation solution, Patient Triage, and we’re piloting this with a handful of PCNs. If you’re unfamiliar with Patient Triage, this software allows patients to submit a short medical or admin query directly to staff at their GP practice.
Within their Accurx inbox, users can now assign patient requests to selected users at other sites to action. Here’s an example of how this might look:
1. A GP in practice A assigns a patient request to the physiotherapy team at the Hub site.
2. Permitted Hub users can then view practice A’s Accurx inbox, and action requests accordingly. To do this, they can message the patient, request responses, send Florey questionnaires, or re-assign requests to other users.
This is a big step towards cross-practice working, and a feature we hope to roll out wider as part of Patient Triage in the near future. Connecting healthcare professionals is a core part of our mission at Accurx, so we support the principle of Hub working as a means of building stronger ties between local services. We’re optimistic about its potential to enable cross-practice collaboration and look forward to realising this potential in our software.