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The Primary Care Trust has asked health provider Concordia Health Limited to operate a new type of GP service which will run two hubs in central Margate and Ramsgate, as well as a mobile unit reaching out into local neighbourhoods and a number of other sites.

The innovative project will offer services in support of those already run by GPs in Thanet, and is designed to tackle health inequalities by taking health services to where the population has the greatest need and catering for people who do not access healthcare that they need. In this way, Concordia's service is designed and targeted to care for unregistered, deprived patient groups who are not currently benefiting from NHS care. Where patients are not engaging with their local GP, Concordia will advise on the benefits of registering with a local practice.

Among the significant improvements available to Thanet residents will be opening times - patients will be able to see a GP or appropriate healthcare professional from 8am to 8pm, 365 days a year, whether they are registered or unregistered. They will be able to make appointments or simply walk in.

This exciting development will be very innovative and work together with local GPs, providing services in new ways that some patients will find more acceptable or convenient rather than the traditional general practice setting.

NHS Eastern and Coastal Kent is investing £9 million over five years to tackle areas of need. These were identified through a multi-agency project called Triple Aim and public workshops held last year.

An even more exciting development for patients will be `hubs' in the centre of Margate and Ramsgate offering specialised services for communities who have previously not been accessing them. These will include services such as substance misuse clinics, offering a substantial presence in areas where these much-needed services have not been seen.

The hubs, largely focused around established pharmacists including Boots UK, will be closely linked to a mobile unit, or health van, which will reach out to the community as never before - for example late opening for homeless people in Cliftonville, and early morning starts in Ramsgate for working men. In addition, the British Red Cross plans to support the outreach programme. Concordia will also work with voluntary organisations such as the Scrine Foundation and Porchlight to address local needs in a joined-up way.

NHS Eastern and Coastal Kent is committed to tackling health inequalities, and educating children and young people to change their behaviours at a young age is seen as key to this. Concordia will work through 12 primary schools to pilot a programme called Making Sense of Health to achieve this aim.

Colin Tomson, chairman of NHS Eastern and Coastal Kent, said: “This is excellent news for the people of Thanet and we are pleased to be able to invest in this service to address health inequalities which we know exist.

“Concordia will provide a strong approach to delivering services in areas where they are most needed, and where people have, for one reason or another, had difficulty accessing basic healthcare.

“I want to reassure local residents and interested parties that introducing this service will not mean any local GP practice will close or that people will have to travel further. On the contrary - this is designed to complement and work in partnership with our current providers. Patients will still be able to visit their current GP practice and continue to receive high quality care.

”This is the latest in a series of investments to benefit healthcare for the residents of Thanet. Among recent developments has been the establishment of a new dental practice for the area - another welcome addition to the package of improvements to local services.”

Dr Tony Martin of Bethesda Medical Centre, Cliftonville, and Dr John Neden, of East Cliff Practice, Ramsgate, who represent GPs in the area, said: “The PCT has listened to our concerns and also looked at our commissioning intentions and recognises that this solution includes some cross over with our commissioning intentions. This model of service will focus on addressing and working with hard to reach communities.

“We need to work together and involve local GPs to ensure that the service is fit for purpose and high quality. This service needs to work with and complement current service provision. The PCT and local GPs recognise that this model will address some of the needs of the Thanet population. The PCT will continue to support the development of the Thanet commissioning intentions.

“This solution will be developed with input from local GPs to ensure that the model of service is not imposed upon local GPs but is developed together to provide high quality care for patients.”

Concordia Health's chairman, Dr Simon Fradd, said: “We are very excited to have the opportunity to address one of the core challenges of the NHS; that of reaching out and giving care to the people who need it most, rather than providing more of the same to the people who already receive care. We will be working very closely with NHS Eastern and Coastal Kent to deliver this scheme, and will involve the public in the development of our services as we go along.”

NHS Eastern and Coastal Kent (PCT) has made the decision to award a five-year contract to Concordia Health Limited to provide additional services which support one of the main objectives in our Strategic Commissioning Plan - to break the cycle of health inequalities. The service will begin operating in the New Year.

Thanet Practice-based Consortium also agrees there is a need to address health inequalities and is committed to “commission services that reduce the inequalities, but which also must encourage every resident to aspire to better health.”

Never before has the NHS in this area invested in a service that proactively challenges existing ways of working to bring about a more co-ordinated approach with stakeholders to reduce health inequalities while still every day provide essential health services. Concordia has proposed a solution which addresses needs in a way which very effectively meets key PCT objectives.

It has long been recognised that Thanet in particular has high levels of deprivation and other indicators of health are poor when compared to other areas of England. The outcomes of the Triple Aim project, which undertook a baseline health assessment of the local population within two wards in Thanet, as well as public health data, helped focus what is really needed to improve the health and wellbeing of Thanet residents. The PCT also held public workshops last year to find out what local people want from their health service.

Two public workshops and a stakeholder event were held last year. The project team also made direct contact with representatives of key marginalised groups using a telephone based survey to gather their views on the key challenges for Thanet, the health services required and workable methods of engagement. The survey was used to shape the definition of requirements along with public health data and the outcome from the Triple Aim project.

The PCT Board made a commitment in March 2008 to invest in additional services which would encourage an innovative way of providing services to those people who don't access, or have difficulty in accessing, primary care services.

Any new services (of which this is one) in an area must go through a formal procurement exercise. The PCT is legally not allowed to award a contract to an existing provider just because they operate in the area and provide similar range of services. The PCT has to show that the new services are offering value for money and the process that they have followed is transparent and fair. The tender documents for Thanet equitable access scheme were published in the local press and the Official Journal of the European Union (OJEU).

Although a number of Thanet GPs expressed an interest in the procurement at this stage, no expression of interest was received from them. That is why it is only now, following the tendering process and the need for commercial confidentiality, that we are able to talk in any detail about the project.

This is not similar to projects commissioned by other PCTs but is a local solution designed specifically for the Thanet community - this is not a polyclinic or Darzi centre in the community but a multi-site service providing services needed in specific areas and giving different access to these services in a new exciting way, linked directly with the local GP practice.

Concordia has said it would like to form a health inequalities forum with representatives from relevant stakeholders including the community and voluntary sector. It is hoped the forum will provide a way to support integrated working to address health inequalities and share learnings and outcomes.

Concordia will establish effective outreach working to contact and treat marginalised groups which will include co-operative working with other healthcare providers, Social Services and third sector organisations.

Three GP clinical advisors, an LMC rep and an Assistant Director of Public Health were members of the project group. This was backed up with public health data and the outcomes from the Triple Aim project.

Concordia has made it very clear it will concentrate on providing health advice and treatment to those patients not currently registered with an existing GP practice. It will not actively poach patients but will obviously need to market its services.

Any unregistered patients will be encouraged to register with a GP practice in their area. Concordia would like to reassure practices that their role is to address health inequalities, rather than to poach patients.

Service	Core Service	Mandatory	Optional
GMS essential services	Yes	Yes
Contraceptive services	Yes	Yes
Maternity medical services	Yes	Yes
Child health surveillance services	Yes	Yes
Cervical screening services	Yes	Yes
24hr, 48hr and 7 day ECG		Yes
24hr BP Monitoring		Yes
Anti-Coag Dispensing			Yes
Anti-Coag Monitoring			Yes
Chlamydia (15-24 year olds)		Yes
Community Based ECG		Yes
Diabetes Care		Yes
End of Life Care		Yes
Extended Opening Option B			Yes
HPV		Yes
Infectious Disease Imm		Yes
Minor Injuries		Yes
OGTT LES		Yes
Phlebotomy		Yes
SDI, IUCD and IUS		Yes
Tissue Viability (Leg Ulcer)		Yes
Treatment Room		Yes
E-booking (Choose and Book)	Yes	Yes
Smoking Cessation		Yes
Substance Misuse (Shared Care)		Yes
Alcohol		Yes
Ethnicity		Yes
Influenza And Pneumococcal		Yes
Minor Surgery		Yes
Learning Disabilities		Yes
Childhood Immunisations		Yes
Osteoporosis		Yes
Multiple Sclerosis			Yes
Near Patients Testing			Yes
Sexual Health		Yes

Locations

Two central hubs - one in Margate High Street, one in Ramsgate High Street. 11 partner satellite locations based at:

Boots UK pharmacy, Cliftonville

Boots UK pharmacy, Broadstairs

Boots UK pharmacy, Westgate

Boots UK pharmacy, Westwood Cross

Scrine Foundation, Cliftonville

Porchlight, Ramsgate

Kent Refugee Network, Cliftonville

Kent Refugee Network, Margate

Red Cross, Ramsgate

Red Cross, Margate

Thanet Community Development Trust, Ramsgate

Health education, through Making Sense of Health, initially with 12 local schools.

Partnership working from the following organisations:

Scrine Foundation

Porchlight

Kent Refugee Network

Red Cross

Thanet Community Development Trust

KCA

Boots Pharmacies in Broadstairs, Cliftonville, Westgate, Westwood Cross