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GPs buried under trusts' workload dump

Seven day 8am to 8pm GP access policy 'under review'

Exclusive Seven-day access will be reviewed to make sure it is 'sensible' for practices, as part of the move to primary care networks, NHS England has said.

Speaking to Pulse, NHS England primary care acting director Dr Nikita Kanani said that the current extended access schemes and funding pots need to be combined to form one service and one funding stream for practices.

She added that the requirement for patients to be offered seven-day 8am to 8pm access was under review.

GPs have called for the review to take workforce into consideration when deciding what practices should offer, and warned against imposing a strict scheme like seven-day access onto practices, instead calling for a scheme that provides what is needed and what will be used, rather than 'access for the sake of access'.

This comes as NHS England and the BMA announced the new five-year GP contract, which said that from July, the extended hours access DES requirements will be transferred from practices to networks, to enable them to ‘deliver at the right scale’.

The change means NHS England will no longer directly pay practices to deliver the service, with the funding going to networks to distribute instead.

Under existing extended hours DES, practices are paid to ‘offer patient consultations face to face, by telephone or by other means at times other than during the core hours’.

But NHS England said it intends to move the service’s funding to networks, coupled with 'the wider CCG commissioned extended access service, to fund a single, combined access offer'.

Addressing whether GPs will still be expected to provide seven-day 8am to 8pm access, Dr Kanani said: 'We're going to review the access requirements for networks, so we will start that from this year essentially. Just to make sure it's sensible.'

Dr Kanani told Pulse she hopes to bring all the currently 'siloed' extended access funding pots together, to form one funding stream and one extended access service.

'We've got five years now, but within that, there are a number of reviews we need to do to make sure we create the right offer for the population, through the networks, and ensure it is something that is doable by practices,' she continued.

According to NHS England, an average network with a population of 50,000 will be required to provide 25 hours extended access per week, which will be shared between morning, evening and weekends. NHS England said the DES will be delivered to 100% patients in every network compared to 75.7% at the moment.

Evening and weekend appointments have been gradually introduced since 2014, on the basis of a Conservative Party pledge which is now promising every patient will be able to book a routine appointment any day or evening by March next year. 

The Government and NHS England have continued to pump money into this scheme, with specific pledges being made in the GP Forward View, and CCGs given earmarked funding.

In all, the NHS has committed more than £200m of new investment for the next year, on top of £144m in 2017/18. More than £500m is due to be invested per year by 2020/21.

But Kent LMC vice-chair Dr Gaurav Gupta said: 'We need to focus our energy on making sure the core services are sustainable, especially in regards to workforce.

'Extended access needs to be what's required, rather than just providing access for the sake of access, which has happened in the past. When we look at the utilisation of sunday appointments for example, they are not being utilised, and the workforce is quite limited to provide them anyway, so what happens with extended access is it takes GPs away from core services.'

'If there is going to be a review, it needs to take into consideration the workforce, and ensure it does not destabilise practices' core hours. It should be what the patients use and what is needed, rather than a blanket policy,' he added.

A Pulse investigation previously revealed that around 25% of evening and weekend appointments are left unfilled, with take-up being the lowest on Sundays, when 37% of appointments go unfilled, followed by Saturdays at 24%. On weekday evenings, 23% of slots go unused.

Viaduct Stockport GP federation chair Dr Jaweeda Idoo said she is concerned workforce issues might prevent networks from fulfilling their requirements.

She said: 'My biggest concern is that we won’t have enough workforce to deliver the outcomes that we want.

'Our responsibility within networks is not just to offer extended hours, which is quite politically driven, it’s about offering what the population needs.'

Last month, the GP partnership review found extended access services entice GPs away from practices, as the work is 'easier'.

The new primary care networks - which will cover 30,000 to 50,000 patients and be led by a local GP in a clinical director role - will see practices receive an average increase of £14,000, just for joining a network.

Readers' comments (11)

  • Well bring it in on 31/3/20 when seniority goes and stand back. Quite extraordinary this complete and utter denial of workforce shortage.

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  • National Hopeless Service

    The problem with trying to undo such 'initiatives' is that it has created a totally false demand of worried well/trivia and second opinion that wont now disappear.

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  • Total agree with National Hopeless Service. It’s the increased demand for definitive answers to trivia that is killing the NHS. It creates impossible task for GPs to manage the hysteria. The extended hours just gives the worried well more time to indulge this

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  • it seems that the dire situation of general practice is finally sinking in a bit to the point where they may be prepared to do a U turn on the promised 8-8/7. It will be interesting to see the issues that PCNs bring up - another major change with little evidence to support it.

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  • @DrSquarred
    "increased demand for definitive answers to trivia" - this is incredibly true and well articulated. People seem to be losing any sense of nuance and perspective and any tolerance of even minor discomfort. The number of patients who kept an appointment to ask about a minor rash or musculoskeletal pain or transient mild abdominal pain that have since disappeared or spontaneously resolved... "I thought I might as well come in anyway, what do you think it was?"
    Sigh.

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  • People don't want 7 day access. They just want to be able to see a GP. If we're not careful we wont even have this soon.

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  • Vinci Ho

    First to all , thanks to those seven-day GP opening protagonists spinning the subject in the last few years. About time to come back to earth , I suppose .
    Alongside with review of appraisal/revalidation , one can see how much the government and its regulatory bodies including NHSE now had to succumb to ‘reality’ which was totally self-inflicted in terms of ‘treatments’ of GPs in NHS in the last eight to nine years .It is totally justified to call it ‘hostile environment’ with the consequences of much less GPs retained and recruited year by year . Shortage of GPs in UK is a common knowledge even in the public .
    The official tone and narrative have clearly been changed but serious damages have already been done . There needs to be period of recuperation and regeneration. Hence , a ‘new’ environment needs to be created for GPs if the government seriously wants to keep NHS alive.
    These politicians and technocrats have a choice to make and it remains that they need us(GPs) more than we need them.

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  • when there is congestion on the road the usual answer is to build more roads, people buy more cars to drive on them, use them more for shorter journeys that previously involved cycling or walking, the roads become congested again. there is a demand for more roads. its human nature. what you need to do is think outside the box and try alternate ways to discourage this behaviour, as in the carrot and the stick for example higher car tax, higher petrol costs, more cycle and pedestrian pathways, better public transport. if you keep repeating the same action you will keep getting the same outcome. same with the nhs, you provide more appointments patients will feel them with more trivial things. its simple logic. totally predictable.

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  • fill them I meant - oops

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  • Pandoras box well and truly opened by fools, difficult to shut now.Need pay as you go not the all you can eat buffet we currently have, this would focus the minds of the punters and the executive into controlling demand rather than keep flogging the increasing unwilling and leaving slaves chained to the sinking roman galley that is the NHS.The last decade has been a disaster with little chance of recovery,spose a bit like GB LTD.

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