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How I made longer hours work for our practice

Dr Michael Loverock explains how he offered extended hours cost-effectively and to the satisfaction of his patients

Dr Michael Loverock explains how he offered extended hours cost-effectively and to the satisfaction of his patients

Like most GPs, my first reaction to the Government's proposals for extended hours was one of anger.

I felt we were being bullied into accepting arrangements that would increase our workload and put more pressure on doctors and staff at a time when our NHS income was falling.

There was also no evidence to suggest our patients wanted these arrangements.

In all the satisfaction surveys over the past four years, there were indeed a few people who suggested we open on Saturdays or, more particularly, in the evenings.

But the vast majority said they were happy with arrangements for accessing our services.

In our practice of nine partners there was a strong feeling that we simply should not do extended hours. So what prompted us to change our minds?

Simple. A mixture of pragmatism and pride. Pragmatism because of the financial implications of not achieving access targets - we have in excess of £60,000 at stake for delivering the required services and achieving high levels of patient satisfaction.

Pragmatism also because we sensed we would be forced to open longer in the end - if not by the Government, then by patients, if they found out they were being denied a service offered by other local practices.

And pride because we have always tried to give our patients the best possible service.

So despite strong reservations we started to write our plan for opening longer.

The consumer approach

At the outset we approached the task from a patient perspective.

We felt this was the sensible thing to do given the consumer- driven nature of the proposals, and if we were going to do it we should at least make sure our plans resulted in our patients receiving a service that was useful to them.

Also, as the proposed DES arrangements for delivering extended hours looked very restrictive and unappealing, we hoped to find a better solution through negotiations with our PCT.

To do this we looked back at the results of patient satisfaction surveys and discussed our findings with our patient participation group.

Broadly, we found there was almost no demand for Saturday surgeries and a small, but significant demand for evenings.

Interestingly, what seemed to concern patients most was the availability of reception and getting through on the phone outside normal hours rather than a wish for appointments.

We developed a plan that would involve the practice changing its opening times

to 8.30am-7.30pm Monday to Thursday, offering nine extra hours a week with GPs working concurrently.

Our building, reception and phone lines would remain open throughout this period.

We agreed with our patient participation group that this was the right way to go, and set about discussing with colleagues how we would staff these new arrangements.

It was agreed that the GPs would all undertake these sessions on a rota, with full-time partners doing more sessions than part-time partners.

For our reception staff we simply asked who would be prepared to alter their hours to cover these sessions.

As all of our receptionists already took turns in finishing late, at 7pm on one or two nights a week, the request that this be extended to 7.30pm was fortunately agreed with little debate and no hard feelings.

We obviously feel fortunate to have such a well motivated and flexible team on reception.

The easing of some of the rules that were first proposed meant submitting the plan was now a formality - we knew we could have more than one doctor doing an extended hours session at the same time and there was no absolute requirement to offer a Saturday service.

We submitted our plan to the PCT in June and, having received approval, started the new arrangements in early July.

Putting our plan into practice

Since July, things have generally gone well and the sessions are gradually getting busier as patients become familiar with the new opening hours.

We have certainly not suffered financially in any way.

The only real difficulty has been around the rota we ran between the doctors.

It resulted in a degree of confusion and some irritation for GPs who were not sure what they would be doing from week to week.

So we recently agreed all nine partners would do one evening a week that would end at 7.30pm.

This means in weeks when all partners are here we offer more than the seven hours required, but equally means we don't have the problem of providing cover when one or two doctors are away.

We also have the added benefit of more staff present in the building, which has increased people's sense of security.

A feedback form survey found 50% of patients using the evening clinics do so because of the convenience and the other 50% because it was the first appointment with the doctor of their choice.

Dr Michael Loverock is a GP in Totnes, Devon

How we got started

The decision process was prompted by:

• financial consequences of not providing the extended hours in the face of other significant financial pressures on the practice

• the wish to provide a good service for our patients

The process was aided by:

• an agreement between all the partners to participate pro rata with their practice commitment

• the backing and support of our active patient participation group

• surgery staff being accommodating and supportive

• excellent practice management well used to managing change

• our PCT being flexible

• weekly practice meetings that allow full discussion

• educating patients with a mailshot (added to flu vaccination invite)

• posting information around the practice and on our website

Dr Michael Loverock (left) and practice manager Andrew Moore Dr Michael Loverock (left) and practice manager Andrew Moore

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