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GP practices to be punished for in-hours closures

GP practices taking part in the extended hours DES will face tighter restrictions on closing during the week for training and admin, under changes to the GP contract announced today.

Under the move, practices that regularly close for a half day - on a weekly basis - will no longer qualify to deliver the DES.

The GPC said NHS England had insisted on the clampdown after a National Audit Office report revealed instances where practices that continued to close for half day every week were still being paid to offer extended hours.

On the back of that report, some national media reports claimed that the 'thousands of practices' closing during the week were to blame for the crisis unfolding in A&E departments.

But negotiators stressed this affects a 'small minority of practices' and that they have agreed some could still be exempted, for example branch surgeries and small rural practices.

The change will also only come into place from October, to 'allow any affected practices time to make appropriate arrangements'.

RCGP chair Professor Helen Stokes-Lampard said the changes 'must not be seen as a lever to make hard-pressed GPs compromise their own welfare and patient safety by forcing them to be open at times which might be impractical and unrealistic for their particular local circumstances'. 

She added: 'Smaller practices might need to close temporarily to allow GPs to make home visits, for example, or for their teams to undertake mandatory training. We need to see very clear guidance about when closing practices temporarily during core hours is acceptable – as sometimes there will be no alternative.'

Dr Peter Holden, deputy chair of the GPC's premises and practice finance policy team, said the move was a case of NHS chiefs 'looking like they are being tough'.

Dr Holden said: 'You can still close for training, and in our neck of the woods it’s the CCG that drives that bloody train.'

GPs have more positive news in terms of other changes to enhanced services.

Along with the scrapping of the unpopular unplanned admissions DES, they are set for a boost in funding for the learning disabilities DES - with an increase in the sum paid for each health check from £116 to £140.

 

Readers' comments (5)

  • Whilst this is unlikely to make significant improvement for healthcare, I think it's reasonable move.

    We close once/month for CCG sponsored PLT to improve quality - we go to formal clinical teaching and practice staff have internal meeting to discuss issues while PNs go to their forum.

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  • If practices close for half day, then surely providing extended hours services helps with appointments?

    Most of the extended hours surgeries are delivered by nurses / hcas anyway aren't they?

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  • Just Your Average Joe

    Sounds great - I will start closing for half a day now - Just so we can't do the extended hours anymore!

    Don't want to do them, can't find anyone else to do them at a price that doesn't mean we are subsidising the service.

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  • While GPC hails this as a success and deflects all concerns and the misery of general practice by proclaiming that this is it! We’ve negotiated a life saver, we’ve made a difference and general practice is finally saved, let’s look at the reason for this hurra optimism and its justification:
    1. CQC –reimbursement: It is a step in the right direction and NHSE will foot the bill instead of GP Practices. Practices are not going to pay for this and it is indeed helpful. However, these resources are going to come out of NHS funding that is our common pot. Tightening a noose round your neck and then loosening it off gives you relief but is that going to put general practice out of misery?
    2. Indemnity: The reimbursement is only for the ‘increase’ in indemnity year to year and not going to cover your already exorbitant rates. Hence, Crown indemnity should have been the aim of GPC and not sticking plaster.
    3. Resilience money: In our area in Kent, we haven’t actually heard of this being offered to any Practices. The deadline to use the money is March 2017, so there goes. It is convenient isn’t it, the final date elapses and government makes a saving. The lack of transparency in the system is at times painful and it would be helpful if criteria for eligibility are disclosed. Once money has been allocated a list of amounts given to and names of Practices given the funding should be made available to all local Practices so we know that firstly, the money has been given and secondly, it has been distributed fairly.
    4. Half day closures: If half the Practices in an area are single-handed, how does GPC make one size fits all reconciliation and accept that these Practices should be punished and not allowed to do extended hours if they close half day. Do they realize that this was protected time for CPD although for most it turned out to be a life saver as we were able to catch up with work that even then spills over to the weekend? LMC and GPC officials all sit in big Practices, there are no single-handers there, the intoxication with ‘large scale working’ has really caused them to completely forsake their colleagues. What about tens of thousands of patients in these small Practices who will now be deprived of extended hours appointments as the Surgeries will not be allowed to provide Extended hours service. I doubt it that single handers will stop half day weekly closures. They have to close on one half day a week, if not for CPD or catching up with work – then at least to attend that hospital appointment or essential errand for which they have only that one half day that helps them survive this madness of general practice and stay sane.
    5. The inability to scrap the Formula and the readiness to ‘reform’ it is a defeat in itself. You cannot have an increase in list size by 100 patients and have a reduction in weighted size by 50 in the next quarter. This is happening under the nose of LMCs and GPC but there is no will to eliminate this Carr-Hill jugglery. GPC can’t reconcile with the statement that the government doesn’t want to budge. It needs to pull up its socks and go back to Simon Stevens. No half measures please. Not any more once we have seen the Irish determination and effectiveness.
    6. QoF has remained unchanged – let’s look at it closely. The increase in value of the QoF point as every year is going to be reduced by increasing the standard size of Practice and thus Practices with lists lower than the new standard continue to lose more and more each year. Thank you GPC, you should have tackled this also instead of just maintaining a status pro quo
    Big Practices get the increase and it is helpful at least to them which is positive.
    .
    This whole proclamation of success has been a desperate attempt to prevent a wave of discontent from transforming into a North Ireland phenomenon. It would make things difficult for an English GPC which has a weak backbone and even weaker will power or stamina which our leaders successfully and, to some extent, justifiably blame on the
    non- cohesive GP community in England.
    GPC has made an attempt to help general practice and it is commendable. Unfortunately, the push is only on driving small Practices into the arms of Federations while the large Practices, will have to continue to struggle with little improvement. The numbers thrown at LMC roadshows are only numbers. When it comes to the final impact, the story will only begin unravelling again.

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  • You are so right.
    CCG members know what to get and apply. Why our locality leads and their practices not named when extra funds go to their practices.
    The weighted list cost us 12% of our global sum.
    Our CCG has promised closure of many practices and community beds.
    They also hope to get £44m from general practice
    What a mess in the south and no LMC or CCG communication of note

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