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How to... plan extended opening in practice

Practice are likely to have to stay open longer in the not too distant future, so get your act together now, urges Dr John Couch

In a recent article I pointed out that the Government's intention to introduce extended opening hours is clear. Rather than wait for an edict, which in typical NHS fashion will give minimal notice, why not at least look at this unpalatable option in advance? Even if you do not implement your plans immediately at least you will have a head start when the fateful day arrives.

Whether we like it or not, APMS bidders are already being encouraged to provide extended opening hours and many offer this service. There are also predictions that out-of-hours providers and walk-in centres will be allowed to offer routine appointments.

If this happens it may not be long after that our list sizes start to shrink as some working patients re-register. This engineered competition will force extended opening hours upon us.

There is no strict definition of extended opening hours. Most practices currently open for nine or 10 hours per weekday and not at all at weekends. The Department of Health will doubtless be keen to let local demand dictate exact hours but my guess is that we should plan for at least two longer weekdays and one weekend session.

Decide the best format for your area in terms of days and times. You may also conduct a mini patient survey to gauge demand and times. Initially consider a 12-hour day on two days a week from 7am-7pm or 8am-8pm.

At the same time at least look at the possibility of a session at weekends. Although none of us wants to contemplate this at present it does no harm to have contingency plans.

Weigh up the options

Consider also whether extended opening hours will be for booked appointments, emergencies or both. Clearly this issue could affect staff morale and the key will be to foster team ownership. Therefore discuss this with staff soon to give them plenty of warning. Canvass staff ideas and personal views and include all GPs.

Extended opening hours may be an opportunity for some to start and finish earlier or visa versa. Consider incentives such as time off in lieu or a higher pay rate for unsocial hours. It may help to state that the aim is not to see more patients but to offer a wider range of consultation times.

If staff contracts have fixed hours individuals are entitled to turn down your request, so it is important to make this voluntary. If you have no takers then you could advertise for more flexible hours opportunistically at each staff vacancy in future.

Security will also be an issue at times when fewer staff and GPs are in the building, one reason why booked appointments may be safer. Assess staff numbers, training, security, panic buttons and need for CCTV.

As you plan make a note of estimated extra costs involved. Inevitably staff costs will predominate unless you can maximise existing staff, GP and nurse time. Include estimates for extra light, heat and security.

Finally, consider how you will inform patients if extended opening hours becomes reality. I really hope the plans are unnecessary but I suspect that we will be using them in 2007.

John Couch is a GP in Ashford, Middlesex

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