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Competition for patients heats up

The Government’s obsession with access is motivated by a desire to see a ‘cut-throat’ market develop, say GPs

By Gareth Iacobucci

The Government's obsession with access is motivated by a desire to see a ‘cut-throat' market develop, say GPs

There is little about the pile of upturned earth in sleepy Shinfield near Reading to suggest a revolution is afoot.

But what is now a building site will shortly be a spanking new APMS health centre, hailed as the ‘groundbreaking' solution to the problems ministers perceive in GP access.

Berkshire West PCT says it will allow patients to see their GP on two evenings a week and on Saturday mornings and intends to write to all of them to tell them about the new hours – and about their option to move practices.

It is one of many such sur-geries in the pipeline designed to make practices far more competitive, in line with Government policy.

Health minister Lord Ara Darzi's interim report on his Next Stage Review has called for half of all practices to open weekends or evenings within three years, with money to follow patients who move as a result.

APMS surgeries like the one in Berkshire are proving a powerful lure for PCTs, although without fresh resources many trusts may struggle to find the money to match their aspirations.

Action plans drawn up by PCTs to improve access vary widely so far with some, such as Sunderland Teaching PCT, using local enhanced service funding to pilot GP extended opening.

Others are hoping to get it for nothing. East Riding of Yorkshire PCT is one such trust, saying it lacks cash over and above its directed enhanced services funding but insisting ‘there is evidence many practices are not looking for additional incentives'.

Dr Thomas Bold, a PMS GP in Derby – another PCT using APMS providers to put the pressure on GP opening hours – is proof of that.

Dr Bold says: ‘I do feel we should be extending opening hours, but I'm probably in a minority. I'd be happy to work an extra few hours on a Saturday morning without any extra money, but I don't think there are a lot of people like myself.'

GPC chair Dr Laurence Buckman certainly is not, urging GPs to fight against being pressured into working extra hours without reward. ‘I don't believe GPs should feel pressurised for no money to work extended hours or on weekends,' he says.

The Government plans a shake-up of the quality and outcomes framework to incentivise improved access, although that is no guarantee of extra funding, since it could involve reallocation of existing points.

Dr David Stout, director of the NHS Confederation's PCT network, says there may be no need to reward GPs, because GPs may be asked not to extend hours but to work more flexibly.

He explains: ‘Local practices could be agreeing to potentially reducing hours during the day to allow practices to open outside of the core hour system – potentially not a financial thing but agreeing variations in practice opening to allow changes in hours.'

To make matters more complicated still, Lord Darzi has said he wants surgeries to allow patients to book advance appointments – a quarter currently do not – as well as enable all patients to see a GP within 48 hours, which the Governments says a substantial minority still cannot.

This for many surgeries will mean a radical shake-up in the way they operate.

‘What the Department of Health would really like is for GPs to cut each other's throats and compete for patients,' says Dr Nigel Watson, chair of Wessex LMCs.

‘They have not said how they are going to incentivise this – whether through the global sum or by rewarding practices for registering patients.

‘But we have to put our house in order. There are still some practices that shut at lunchtime or don't offer any services before nine or after five.'

Dr Charles Alessi, a GP in Kingston, south-west London, also believes GPs must embrace more flexible hours, but warns: ‘The biggest problem is changing the way people work.'

Ministers may be obsessed with extending GPs' hours, but they seem unlikely to spend much of the £20bn extra NHS funding on paying them to do so.

Case study: Atos Health APMS practice, Berkshire

Nigel Beverley, director of NHS services at ATOS healthcare, says the company wants the new Shinfield practice to be ‘a showcase example of what modern, accessible high-quality general practice needs to look like'.
The new surgery will allow patients to book to see their GP on Tuesday and Thursday evenings up until 8.30pm as well as on Saturday mornings up until noon.
Mr Beverley, who expects the staff and patient list to grow ‘substantially' over time, says Atos will definitely look to offer services like this on a wider scale, and will look to procure ‘in excess of 20 practices' across the country in the next few years, all offering extended opening hours.
‘As a general starting point, we would certainly look to extend the opening hours,' he says.
‘We believe that patients want better access in the evenings and weekends.'

Dr Charles Alessi: the biggest problem is changing the way people work Dr Charles Alessi: the biggest problem is changing the way people work

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