Northern Ireland has some of the longest outpatient waiting lists in the UK. Annual demand for elective services currently exceeds capacity by around 60,000 assessments and 35,000 treatments. While the historical approach of allocating additional funding benefited a number of patients, managing elective waiting times with short term funding does not provide a sustainable solution. There was therefore a need for a long-term solution to better address the demand for elective care services and to deliver sustainably shorter waiting times for patients. Through the Health and Social Care Board GP federations were commissioned to design and deliver  a range of pathways to manage patients more appropriately in primary care without the need to refer to secondary care. 5 pathways were developed.

• Dermatology
• MSK
• Gynaecology
• Vasectomy
• Primary Care Surgical Service

Each Federation area identified a Hub Practice and GPs with enhanced skills (GPES) to provide clinical services to patients, with the model replicated across the region. Beyond providing primary care capacity they support an improved approach to demand management via peer support, peer review, peer education, self management and self-directed care at a population level within federations. The aim of the service is

1. To allow a greater number of patients with common conditions to be managed within primary care setting thus improving patient experience.
2. To improve capacity within primary care and investigation services by providing an alternative service. Patients being seen in a timely fashion by a primary care clinician in their own practice or a neighbouring practice and follow up within primary care as appropriate.
3. To improve the skill base in the across Federations and will enhance the quality of referrals to secondary care.

The education and demand management arm to the model sees educational and training events aimed at improving knowledge in managing common primary care conditions as well as supporting GP colleagues to train and certify in LARC techniques and joint injections, thereby increasing the skill mix within primary care to deal with these conditions.