Primary Care Foundation Blog

These blogs are about the NHS - but also about numbers. I hope that they raise some interesting points that come from the data. Sometimes I suggest that the data doesn’t look right - but maybe it is. Please tell me when I have got it wrong (as we all do, however carefully we look at it) or when I have got hold of the wrong end of the stick. And especially tell me if you can see a rationale or logic for the picture that I describe that I have missed.

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Home visits – a risky business?

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At the end of March 2016 NHS England issued a patient safety alert on ‘Risk of death from failure to prioritise home visits in general practice’. The alert tells of a practice which while having a system to mange visits did not have a system for prioritising potentially urgent calls requiring an early response and rapid clinical intervention. The GP made other visits and did not have time to see this patient until the evening but before the GP arrived the patient had collapsed and had to be taken to hospital by ambulance and subsequently died.

Cases like this are unusual but on looking back at the National Reporting and Learning System, NHS England found another 11 incidents resulting in death or severe harm over the last two years. There may, of course, be others that were not spotted and reported.

This is an issue that the Primary Care Foundation specifically picked up in our 2009 report for the Department of Health, sent to all practices, on ‘Urgent Care in General Practice’. We developed a system and process to help practices become better organised to respond to all requests for care - not only urgent requests.

We have now worked with over 1,500 practices across the UK looking broadly at access and giving information to practices to help them identify how to improve. Often we find that the issue is that patients are coming back more frequently than would be expected and the question becomes how to address this.

But we also look specifically at how requests can be assessed and if necessary spoken to by a clinician within a reasonably short period of time - thereby avoiding the practices running the same risk identified in the patient safety notice.

So what practical steps can you take, particularly when most practices are feeling under increasing pressure to manage a rising workload? Practices have come up with a range of different solutions but they tend to combine a better system for spotting urgent cases with a reduction in the overall workload. So scanning all home visit requests – or finding a way that suits you of rapidly calling people back – can both identify that up to half of the home visit requests don’t really need a visit at all and can be managed in other ways while also spotting the very few that need a really rapid response.

Many practices use the duty doctor to screen home visit requests and make sure that they also have capacity to carry out the visit, while other practices build in a gap in the morning (so perhaps a couple of 10-minute appointment slots) to allow a GP to review requests that have come in and to carry out any telephone assessment of other cases too. Smaller practices find this works for them, but that visiting the patient is harder. But there are a number of examples of single-handed practices working together to set up a home visiting scheme with a GP able to cover a number of practices (see the case study in our report from Halton & St Helens).

If you need more help with managing home visits or for more information about the help we can provide with improving access do feel free to get in touch with me on This email address is being protected from spambots. You need JavaScript enabled to view it.

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Guest Friday, 22 June 2018

About Us

The Primary Care Foundation was established to support the development of best practice in primary and urgent care.  The three Directors bring different skills and perspectives to understanding primary and urgent health care - for more details click below:

David Carson

Rick Stern

Henry Clay



Latest News

New on-line registration for the potentially avoidable appointments audit

The Primary Care Foundation were selected by NHS England to further improve and automate the audit of potentially avoidable appointments. We are now building a new website with Method Analytics that will make it much easier for any practice to register online, will simplify data collection for clinicians, and will allow for instant reporting on results. The reports will be much easier to understand and will signpost other support. And it will remain free to use for all practices in England.

We are now ready to go live with a new ‘test’ site. We are confident it is already easier to use but we are keen to get any feedback from practices before the new website is fully up and running.

If you are a practice in England and you want to register, CLICK HERE  and click on ‘register here to create a practice audit!’ You will be guided through registration and how to set up your clinicians to take part in the audit.  This is a new test site, so if you notice anything that doesn’t look right, or could be made easier, just let us know.  And the same for your clinicians as they enter data – any feedback at the moment – good or bad – would be really helpful … just email us This email address is being protected from spambots. You need JavaScript enabled to view it.


What do we mean by an ‘avoidable appointment?

The latest blog by Rick Stern ‘If only …’ explores the idea of avoidable appointments, what practices have gained from the audit, and what might be possible with further investment in general practice. It is available HERE and will also be published in Health Care Leader.


Are there any simple lessons for practices looking to improve access?

A feature article in Management in Practice by Rick Stern reviews what we have learned from working with over 1,500 practices across the UK – you can read the full article HERE  


Integrated Urgent Care – how to make NHS 111 work

A lead article for Health Care Leader by Henry Clay describes a financial and capacity model developed for NHS England, the potential benefits and pitfalls, and what we have learned from working with a dozen areas to apply the model. The article is available at HERE and a fuller version with a number of explanatory graphs can be downloaded HERE


Integrated Urgent Care – opportunity for support to your locality

We have developed a financial model for the Integrated Urgent Care Team at NHS England that focuses on the NHS 111 and OOH ‘front end’ to an integrated urgent care system (but also looks at the cost of onward referrals to other services). This is proving to be an invaluable tool for both commissioners and providers. It is now available to use and NHS England have also agreed to support some sites to setup and work through the model with PCF’s Henry Clay who developed the model. For further information please contact Henry on This email address is being protected from spambots. You need JavaScript enabled to view it.


We are now supporting over 1,500 practices across the UK to manage access and urgent care

Our support for general practices looking to improve access for patients and streamline the management of urgent care continues to expand. Based on a web based tool, developed out of our work commissioned by the Department of Health, we collect practice data for one week and prepare a report for each practice looking at how you compare to others and explore what this means for making practical changes in the way you work. We are regularly improving the format of our reports for practices based on constant feedback. If you would like to see an example report, CLICK HERE.  If you want to know more about how we might work with you please contact Rick Stern on  This email address is being protected from spambots. You need JavaScript enabled to view it.  or call on 07709 746771.