Extended hours favour rich over poor
The Government’s target was for 50% of practices to offer extended hours, but it was always likely that this proportion would eventually be exceeded.
The Government's target was for 50% of practices to offer extended hours, but it was always likely that this proportion would eventually be exceeded.
The prospect of losing an average of £18,000 per practice – money tied previously to access, choice and the QOF – was just too big a stick for most GPs. Not all, however. The latest Government figures reveal 71.1% of practices in England offered extended hours, up just slightly from 68.9% at the end of December 2008. A hardcore of almost 30% look likely to remain extended hours refuseniks.
The reasons cited for not taking up the extended hours cash are many and various, from deep ethical objections over access-dominated healthcare, to a desire to preserve work-life balance, to an absence of competition from neighbouring practices. But for many GPs who are not offering extended hours, the reasoning is more straightforward. They simply cannot make extended hours work, practically or financially, for their practices.
Small practices do not have doctors to run the shifts, those in isolated rural areas can't justify running empty surgeries and practices in deprived areas struggle to persuade staff to work in difficult locations at unsociable hours.
The Government will claim GPs had a choice of whether to offer longer opening hours or not. The reality is that most GPs took the only option they could.
Widening health gaps
It is for this reason that the results of Pulse's investigation this week are so significant.
Our findings show that practices in the poorest areas of the country are those least able to offer longer opening hours – with many losing thousands of pounds of funding as a result.
Only 61% of urban practices in the highest quartile for deprivation are opening out of usual surgery hours, compared with 75% of those in the least deprived quartile. There may be questions over how many patients really wanted longer opening hours, but presumably ministers did not intend such access should be denied to those in the poorest areas of the country, particularly as it is these patients who often find it hardest to take time off work.
Our figures also reveal the degree to which the extended hours policy is driving another part of the Government's agenda – the push for fewer, bigger practices. Singlehanders are little more than half as likely as practices with four or more partners to offer extended hours, creating a stark funding imbalance and a powerful impetus for practice mergers.
The extended hours policy is giving from the small to the big, and the poor to the rich. The Government needs to answer how this squares with its professed aim to tackle health inequalities.editorial