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How to make the best of the extended hours DES

If you opt to do the extended hours DES, ensure you take maximum advantage of the opportunities says accountant Bob Senior.

If you opt to do the extended hours DES, ensure you take maximum advantage of the opportunities says accountant Bob Senior.

In last week's article I made the point that some practices might think it worth losing 48 per cent of an £18,000 DES when compared with the costs and disruption of extending their opening hours.

But I also made the point that the equation should be looked at very carefully. Suppose by not staying open longer you start loosing patients? This would be a disaster.

Some practice's may feel that the proposed extension of surgery hours may not be of much interest to their patients. There will be some patients will be keen to see their doctor between 6:30pm and 8:00pm, but there will be many, including in particular elderly patients, who will not.

Practices who believe their patients will not be concerned if they don't provide extended hours may decide to stay shut. They will feel the costs of providing the extra hours don't justify the potential income and will decide not to bother participating in the DES.

If there is little risk of losing patients from their list they may well simply accept the reduction in income and not provide extended hours. (Of course Saturday morning opening might be a different matter, but it remains to be seen on which days practices will elect to provide the extra appointments required.

However, for those practice's with perhaps more demanding patients, or perhaps operating in a more competitive environment, the financial risks of not providing extended hours are much more significant.

If patients start to leave the list to move to surgeries that do offer extended hours, a practice could lose income of over £100 per patient per year, in addition to the money lost from not taking part in the DES.

Losing 500 patients say could easily reduce a practice's income by over £50,000 a year. It is most unlikely any practice could accept that scale of loss. In reality many practices will be forced to offer extended hours simply to mitigate their losses.

So, if practices are going to offer extended hours how can they make the best of it? If the surgery is going to be open and reception manned, you should aim to do more than simply have one doctor seeing patients.

If a practice is going to have to have two people on duty in addition to the doctor then it would make sense to offer other services at the same time. Examples might include running a Travel Clinic, perhaps routine smears, flu clinics etc. Some of these clinics would bring in additional income while others would take pressure off the daytime usage of the surgery.

Childhood Immunisation is one area where many practices struggle to achieve the maximum targets and miss significant amounts of income, partly due to parent resistance but also in many cases because of parent apathy.

Running clinics outside the normal day might enable practices to reach those parents who struggle to fit immunisations in around work and child care arrangements.

Using two reception staff to support two or three clinical staff at a time is a much more efficient use of resources than simply having them in the surgery for one GPs appointments.

Practices need to think laterally about how they might make the most of the extra sessions they are providing. In theory the extra appointments are in addition to the existing practice appointment capacity.

Might it not therefore be possible for the practice to use some of the extra capacity to actually cater for a growing list?

Given that a full time GP might be expected to look after a list of somewhere between 1,800 and 2,300 patients, then providing three hours a week extra appointments could translate into being capable of taking on between 200 and 265 extra patients.

If that were to happen it would have a knock on effect on the number of extended hours that the practice would have to provide, however the extra patients would bring with them additional income of perhaps £20,000 to £26,500 per annum.

It is debateable whether or not extended hours appointments will be welcomed by those patients who visit the surgery regularly.

It could be argued that it is those patients who don't visit their doctor very often who believe they would like the opportunity to do so after work. So think of it this way: from a financial point of view maybe they are the patients practices might like to attract.

They are patients who join a practice list because they know they will be able to get a late appointment if they need one, but in fact they rarely do need one . So they bring with them an annual Global Sum payment without actually adding significantly to a doctor's workload.

Bob Senior is director of medical services at Tenon, the UK's third largest medical accountant

Next week: Andrew Lockhart-Mirams answers GPs' questions on the extended hours DES

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