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GPs face penalties for in-hours closure

By Steve Nowottny

Pulse exclusive: Practices that close for lunchtimes or a half-day are set miss out on the extra cash being offered for extended hours.

The Government plans to crack down on lunchtime and half-day closing in practices by attaching stringent conditions to the new extended hours DES.

GPs will only qualify for extended hours cash if they make up for any in-hours surgery closures, Pulse has learned. A practice that closed for an hour every lunchtime would have to open eight extended hours a week, rather than the proposed three.

The Department of Health has instructed all PCTs to begin monitoring GPs on a monthly basis to ‘ensure extended hours are genuinely additional'.

A document circulated by the department to SHA chiefs – and obtained by Pulse – warns: ‘Any closures during core hours, such as lunchtimes or afternoons, would negate against extended opening.'

It also adds to fears that the 1.5% uplift will be spent on extended opening, suggesting PCTs should aim for even more than three extra hours per week, and should press for both Saturday and evening surgeries.

The move came in the same week relations between GP leaders and the Government reached a new low, with health secretary Alan Johnson going above the BMA's head to write directly to GPs, urging them to vote to accept the Government's contract offer.

Ministers accused the GPC leadership of ‘misrepresenting' its proposals.

All UK GPs will be polled on the contract offer this month, with the GPC meeting to discuss the exact wording of questions later this week.

But the DH document instructs PCTs to begin the process of extending hours right away, by auditing all existing opening times.

Under the GP contract, practices are responsible for patient care from 8am to 6.30pm, but are permitted to set their own opening hours.

No official estimates on the number of practices that close during the day are available, but a Pulse survey of 50 practices on the NHS Choices website found 92% currently close at some point between 8am to 6.30pm.

The new guidance drew a furious response from the GPC, which claimed it showed the Government was ‘already implementing' extended hours plans ahead of this month's poll.

Dr Stewart Drage, GPC negotiator, said: ‘What it's really trying to do is bring back the old hours of availability through the back door. Is it deliberately upping the ante to make us more angry?'

Dr Sinead Rogers, a GP in Northampton who plans to reject the Government's offer, said the guidance showed a ‘total misunderstanding of how we work'. She added: ‘We're not actually seeing patients every 10 minutes from 8am to 6.30pm, but we're taking part in other activities such as home visits, business meetings and paperwork.'

The department said the document was aimed at allowing PCTs to direct funding for extended hours to those who were providing it and prevent ‘substitution' by practices that might begin closing at other times.

Extended opening DES conditions

DES conditions

MONTHLY MONITORING
PCTs to ‘conduct a baseline audit of current GP appointment availability as the basis for subsequent monthly monitoring'.

NO DAYTIME CLOSURES
PCTs ordered to ‘identify any closures during core hours, such as lunchtimes and afternoons, which would negate against any extended opening'.

MORE THAN 3 HOURS EXTENDED OPENING?
Practices asked ‘whether in principle they would be interested in providing more than this'.

NO FLEXIBILITY
‘PCTs should ensure a robust understanding of patient preferences for extended opening.

Source: DH documents circulated to SHAs<.em>

The Department of Health letter to PCTs on improving access The Department of Health letter to PCTs on improving access

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