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At the heart of general practice since 1960

Competition for patients begins as GPs take up extended hours

By Steve Nowottny

Many PCTs are already meeting the controversial target to force half of practices to offer extended hours – 10 months ahead of the deadline set by ministers, a Pulse investigation reveals.

NHS managers are also seeing initial signs of success in their drive to ramp up competition between practices, with examples emerging of GPs openly marketing their longer opening hours to tempt patients away from neighbouring surgeries.

A Pulse survey of 50 PCTs found half have begun signing up practices to extended hours and 50% of practices in those areas have agreed to open at evenings and weekends. In some areas, 87% of practices are already offering extended hours.

LMCs have had varying degrees of success in their attempts to strike local enhanced service deals that address key GP concerns around the extended access DES.

Some PCTs are allowing some flexibility over whether practices can double-count periods when two GPs work concurrently, while others have agreed to fund extended access via an hourly rate of up to £150 per hour.

Dr Nigel Watson, chief executive of Wessex LMCs, said some PCTs in his area had agreed LES schemes that allow smaller practices to limit Saturday opening to one week in four, while others had accepted practices opening for half an hour rather than an hour in the morning.

Other trusts are sticking doggedly to the terms of the interim DES, condemned by the GPC for failing to cover practices' running costs and putting GPs working alone at risk of attack.

Several PCTs said they did not expect extended opening to start until July and negotiations remain stalled in many areas because of the dispute over this year's pay award.

The survey also uncovered examples of practices taking to heart the interim DES demand for GPs to promote their additional sessions to help patients decide where to register.

The Gosforth Valley Medical Practice in Dronfield, Derbyshire, is publicising its Tuesday evening surgery on its website, telling patients: ‘These appointments can also be used by patients from other practices in the town, should they wish to change practice.'

Dr Richard Bull, a GP at the practice, said that while he was not aware the ‘low key' advertising had yet convinced any patients to switch practice, extended opening was extremely popular.

Dr John Grenville, chair of Derbyshire LMC, said he would have preferred the practice to use ‘a different form of words' to promote its opening hours.

Dr Barry Moyse, vice-chair of Somerset LMC, said the wording was ‘a bit iffy' but reflected the growing reality that practices were in competition for patients.

He said a third effective pay freeze had left many practices with little option than to sign up to extended hours. ‘To have this rammed down our throats leaves a bad taste. But I think when the sound and fury died down, many practices realised they were seriously concerned about cash flow,' he added.

Open all hours? PCTs' opening hours success

88% of PCTs are offering or planning to offer a local enhanced service, some mirroring the interim DES, others offering greater flexibility or hourly payment

50% of PCTs currently signing up practices to do extended hours

50% - GPs in those areas signed up to extended hours

87% of practices in some areas now open at evenings and weekends

18% - total number of practices already doing extended hours

Source: Pulse survey of 50 PCTs

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