Extended hours stripping cash from poor practices
By Steve Nowottny
Exclusive: The Government's extended hours drive has stripped millions in funding from small practices and those in the poorest areas of the country, a major Pulse investigation reveals
Small practices find it far harder to offer evening and weekend appointments than those with large numbers of partners, putting them at a serious competitive disadvantage and providing a powerful impetus for practice mergers.
Only 44% of singlehanders and 60% of practices with two or three partners are offering extended hours, compared with 83% of those with eight or more partners, shows our analysis of 200 randomly selected practices from more than 100 PCTs.
And there is evidence the extended hours policy is widening the gulf between rich and poor. Only 61% of urban practices in the highest quartile for deprivation were receiving the average £18,000 annual payment for providing extended hours, compared with 75% of those in the lowest quartile for deprivation.
Payments were recycled from other parts of the contract, meaning practices that are not offering extended hours have lost funding compared with last year.
The GPC called on the Government to look at the data and provide flexibility on the rules for offering extended opening, amid fears small practices and those in poor areas were struggling to find doctors to cover shifts at unsociable hours.
GPC negotiator Dr Chaand Nagpaul said: ‘If the Government wants GPs to provide extended hours, it needs to look at the incentives offered and the flexibilities. There are economies of scale at large practices that make it easier for them.'
Government figures show the proportion of practices not offering extended opening has stabilised at almost 30%.
Pulse's investigation identifies for the first time exactly which practices are opening longer – based on calls to each practice to confirm extended opening, data on practice size from NHS Choices and indices of deprivation data from the Office for National Statistics.
Much also depends on the location of the practice. Some 68% of urban practices offer extended hours, compared with 59% in rural areas.
Dr Asad Mubarik, a GP in Rochdale, Greater Manchester, said his ‘semi-rural' practice could not afford to open longer.
‘We would make a loss if we did,' he said, adding practices in deprived urban areas also faced safety concerns. ‘Opening in deprived urban areas can be very scary. I know a GP who was assaulted after work and ended up in intensive care. The number of staff you would have to have working in the evening would be significant.'
Dr Krishna Chaturvedi, a singlehanded GP in Southend, Essex, said his practice had not taken up extended opening partly because of the difficulty in persuading staff to work evenings and weekends.
‘Larger practices are historically well-resourced and supported by medical and nursing manpower,' he said. ‘I feel it is a very unfair competition.'
But a Department of Health spokesperson said: ‘The issue is not the size of practice, their location or the patients they treat – it is whether GPs make the decision to provide extended hours for their patients.
‘In some PCTs, nearly 100% of practices, from singlehanded to large surgeries and in both urban and rural areas, are delivering extended hours.'Which practices are opening longer?
61% Urban most deprived quartile
75% Urban least deprived quartile
Source: Pulse analysis of 200 practices