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GPs told to stop closing for half-days or risk losing £40k in funding

GP practices have been warned to stop closing for half-days or risk losing £40,000 in funding, according to new plans by NHS England.

The plans to withhold funding come as figures show over 700 practices in England regularly close for part of the working week, according to findings from the Daily Mail.

NHS England has said it will crackdown on half-day closures by withholding the extended hours element of the funding for primary care networks.

This means a practice which closes for a half-day without permission from its local health chiefs will lose its share of funding – around £40,000 – from a typically-sized primary care network of five practices.

Figures show in 2018/19, 722 practices were shut for part of the week, 197 of which initially did not declare they were closed for a half-day. Additionally, 38 practices reported their total opening hours amounted to fewer than 45 hours per week, lower than the contracted 52.5 hours per week.

The BMA has said instead for 'threatening' GPs by reducing their funding, NHS England must address the GP recruitment and retention crisis as a solution to 'lasting improvement to patient care.'

BMA GP committee chair Dr Richard Vautrey said: 'It is disingenuous for NHS England to be so categorical in claiming they know exactly how many more appointments would be available if practices changed their opening arrangements.

'The potential impact of these changes must be considered - for instance GPs may no longer be able to do evening or weekend appointments because of additional commitments during the day.

'Every GP practice wants to be able deliver the best for their communities in the 21st century but with significant workforce shortages, and a failure of NHS England to invest in much needed premises and IT infrastructure, it has left GPs under greater pressure than ever before.

'And so instead of coming up with fantasy figures and threatening GPs with reduced funding, NHS leaders must work to address the ongoing recruitment and retention crisis to bring about lasting improvement to patient care and avoid putting overworked doctors under further strain.'

RCGP chair Professor Helen Stokes-Lampard said the regular closing hours stem from larger practices or from smaller surgeries that are ‘forced to’ because of staffing shortages.

She said: ‘It is also more likely that it is ‘branch’ practices that are affiliated to larger sites that have regular closing hours - or very small practices that are forced to close due to staffing shortages. In either case, adequate cover arrangements will always be put in place for patients who need urgent care and, wherever possible, patients are fully informed well in advance, and explanatory messages are posted on websites and surgery answer machines.’

Dr Nikita Kanani, NHS England acting director of primary care, said the move to curb half-day closures is to free up ‘hundreds of thousands of appointments’ to patients.

NHS England estimates a routine half-day closing could have lost over 22,000 hours of weekly GP time last year.

She said: ‘By curbing half days closures, we will be freeing up hundreds of thousands of appointments at a time when we know it can sometimes be tricky to see your GP.

‘While occasionally practices need to close for training that ensures the up-to-date skills of family doctors, our changes aim to further reduce regular half-day closures and improve the availability of appointments across core hours in the week, supporting the best possible patient access in primary care.’

But Professor Stokes-Lampard said it is ‘disingenuous’ to imply that practices are ‘shirking’ their responsibilities to patients and added that the closures are usually down to GPs performing other vital tasks, such as conducting phone or online consultations.

She said: ‘GPs and our teams are working under intense resource and workforce pressures - and it is disingenuous to insinuate that we are in some way shirking our responsibilities to patients’

‘On occasions when practices are closing during routine hours, it is not time "lost" to patients, it is usually time spent conducting telephone or online consultations, or making home visits - or some of the other many vital tasks that GPs and our teams are required to do, such as complying with mandatory or statutory training.’

She added: ‘The introduction of primary care networks in England should make it easier for GPs to optimise what they can do within routine hours - and we have already seen a significant drop in practices temporarily closing over the last year, which coincides with the period they have been introduced.’

It comes after the GP contract placed tighter restrictions on practices taking part in the extended hours DES who closed during the week, saying they would no longer qualify to deliver the DES. 

NHS England recently scrapped its controversial £3m network accelerator programme, which offered up to £200k to networks as a reward for its progress.

Readers' comments (28)

  • NHSE Directive = beatings will continue until morale (and output) improve
    Primary care networks have been ‘operating’ for a month, and yet HSL attributes fewer practices capping their list in the last year to this? PCNs haven’t done anything yet! Perhaps we should have a competition attributing various implausible successes to PCNs apparent magical powers. The sun is shining outside my window this morning - well done, PCN!
    HSL shouldn’t be so keen to hitch her credibility to another bandwagon, the wheels having fallen off the GP 5 year forward view.

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  • How will you be freeing up more appointments when theres no one to work? Its beyond belief sometimes.

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  • Perhaps the learned Dr Kanani fancies a trip to Grimsby: 1/2 Thursday for 25 years and last one I did (covering 3 GP's) I received precisely no calls, along with being unable to fill my late appointments before the PCN's and extended access took over!

    No evidence on Friday AM of excessive OOH or A/E usage to boot.

    Oh yea don't have PPG either as cant get patients to join/set one up.

    While I'm waiting for the inevitable call as a consequence of above comments I'll take on aspects of cleaning duties and stick broom/mop up my "a**e"

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  • If GPs are wanting to reduce workload because of the pension fiasco, how will HMG be able to generate more appointments?

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  • Cobblers

    "Dr Nikita Kanani, NHS England acting director of primary care, said the move to curb half-day closures is to free up ‘hundreds of thousands of appointments’ to patients."

    Showing your ignorance of how Primary Care is run doc. Good job you're only 'acting' director of primary care. Might be a good idea to get back to politics, in which you are admirably suited.

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  • How many GP`s, particularly single handed ones needing that "half day" to catch up will simply say "To h++ll with this" and quit and hand back their contracts. Far less, not more appointments.
    Of course destroying single handed GPs is all in the plan from on high but that is yet more appointments lost.
    If you want more appointments, change or scrap appraisal, I`m leaving for good in 6 weeks time at 54 because I can`t face another appraisal.

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  • Again the myth of the independent contractor status is exposed. GPs are either free to organise their own business within the limits of the contract - “access to services” being undefined - or they aren’t.

    Do what my old practice did when the CCG “winced” that we closed on Thursday afternoon for admin/training/cps with a duty GP available by phone for emergencies. Open the surgery door and pay a receptionist to answer the phone. Number of extra appointment slots? Zero. Difference made? None. Morale of GP? Even lower.

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  • you are legally obliged, as an employer, to provide a break after 6 hours of continuous work. so the being open for 52 hours plus for a single handed GP is illegal if they don't shut the practice for a lunch break. just saying.

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  • Nikita, how did you get through school (never mind medicine)?
    Let’s do some speculative ‘baby’ maths.
    A practice losses 40K gross for the default.
    This is less than 20K net income (not counting other expenses).
    This is divided between average of five doctors, so a loss of about 4K each for an afternoon off - quiet a lot!!!
    BUT
    ...it is an afternoon...like every week... like 52 of them...so let me see...4K divided by 52, equals...NO...£76.92
    Well, that’s a no-brainier - how about organising more afternoons off?

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  • Bob Hodges

    Did Nikita Kanani REALLY say that?

    I'm going to venture that was an attributed sound bite actually written by someone who hasn't got a fucking clue about about how General Practice functions, even in its most basic form.

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