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Revealed: More than half of CCGs considering plans for GP extended hours

Exclusive More than half of England’s CCGs are already considering plans for extended opening in GP practices above and beyond the current incentivised service, with more than a quarter at the stage of actively planning such schemes, Pulse can reveal.

Figures obtained from 129 CCGs under the Freedom of Information Act reveal that 57% of CCGs are either actively planning commissioning of extended hours - above and beyond NHS England’s extended hours DES and the central pilot scheme announced by the Prime Minister - or are considering doing so.

The schemes being actively planned are a variety of extended services funded by CCG money and, in some cases, approved bids from the central ‘winter monies’ pot, the £500m the Government is giving to certain areas to deal with urgent care pressures this winter.

As previously reported by Pulse, practices around Greater Manchester will be taking part in a £2m scheme to improve services to patients, including access, while three practices in Westminster in central London will open a weekend walk-in service to registered and non-registered patients.

But this investigation reveals the extent to which CCGs are planning to commission such schemes across the country, with a quarter of CCGs citing a reduction in A&E pressures as their main reason for pushing ahead with extended hours.

A total of 129 CCGs responded to Pulse’s request. Of these, 57% said they were planning or considering extended hours schemes, with only 9% saying they were not planning any such scheme. The remaining 34% said they did not hold any information. Of the 129, 26% were actively planning these schemes, with 31% considering plans at this stage.

NHS Wiltshire CCG has said it will extend GP hours using a £450,000 pot of money part-funded by the CCG and part-funded with winter monies while NHS Lewisham CCG will pay GPs £100/hour to extend opening as part of a local urgent care incentive scheme aimed at reducing winter pressures. NHS Ealing CCG has said it will invest £90,000 towards GP morning walk-in sessions and £300,000 towards a morning ‘duty doctor’ scheme, also funded with winter monies.

Other CCGs considering commissioning extended hours include Oxfordshire, Islington, Waltham Forest, Camden, North Durham, Brighton & Hove and Nottingham West.

The news comes after the Government announced a £50m ‘pioneer’ scheme across England, which GPs will be able to bid for from December in return for providing improved access in weekends and evenings as well as via new technology.

GPC deputy chair Dr Richard Vautrey said he was ‘not surprised’ at the number of CCGs formulating plans to extend hours, especially in light of the recent political focus on this area. He warned that the real test would be whether the Government would commit to fund extended hours in the longer term.

He said: ‘PCTs previously have commissioned extended GP opening in various ways so these figures do not surprise me in light of the recent focus on this area. The important issue is that practices need to be able to plan for the long term and take on additional staff. Otherwise the risk is that even with additional short-term resources, all that happens is that the current workforce is either spread more thinly and therefore the quality of the current in-hours service is put at risk, or clinicians are encouraged to work longer hours with the risk they become more tired and make mistakes. In addition there is little point practices opening longer if the necessary support services are not available as well.’

Dr Vautrey added: ‘Clinicians in practices and out-of-hours organisations are working harder than ever before. What is really needed in a long-term commitment to increase the funding general practice receives so that this increased workload can be dealt with by expanding the general practice workforce.’

Dr Charles Alessi, chair of the National Association of Primary Care, welcomed the CCGs’ plans. He said: ‘Extending the hours of availability for general practice is a good thing and should not be looked upon negatively as long as it is the start of a “whole system” redesign and as long as this does not mean GPs working even longer hours than they work now.’

‘There are plenty of schemes which improve access for patients and this is one of them. It is perfectly reasonable that the people who work extended hours should be adequately remunerated.’

Dr Ivan Benett, clinical director at NHS Central Manchester CCG, which is receiving £500k of the £2m funding for CCGs in Manchester, said: ‘Our overriding ambition is to provide a service for the people of central Manchester that is consistent and of the highest quality. We have pockets of excellence but also great variation in activity and outcomes. The first step is to be available when people are ill, or believe themselves to be ill. This means increasing the capacity in primary care to see more people at the times they are able to access the service.’

‘Our aim is to begin to offer longer opening times by this Christmas to the population of one of our localities. Primary care will be open for business 8am to 8pm weekdays and for three hours on Saturdays and Sundays. When surgeries are closed people will be seen at a locality hub. We want people to come to this service rather than go unnecessarily to A&E, especially between 6pm and 8pm.’

Examples of extended hours schemes:

NHS Ealing CCG - will run two schemes to approve the availability of GP appointments funded by ‘winter monies’. Monday to Saturday it will run a GP walk-in service that will see practices opening for morning sessions which patients can access without an appointment six days a week - this scheme has been allocated a £90,000 budget. A second scheme, worth £299,520, will see GP surgeries offering a ‘duty doctor’ service two days a week (proposed to be the two days a week when practices experience the highest demand for appointments).

NHS Central Manchester CCG - A small number of practices will open for additional hours until 8pm Monday to Friday and for six hours over the weekend (expected to be three hours on Saturday and three hours on Sunday). Part of the Greater Manchester ‘demonstrator project’ in which central Manchester is one of six areas participating, There is no defined staffing requirement, other than ensuring GP availability. The CCG has been allocated £500,000 for the project as a whole, with a large proportion being put towards extending access.

NHS Central London CCG - will be paying GPs £94/hour to run a walk-in service at weekends open to both registered and non-registered patients. CCG leaders say that the scheme, which has a £250,000 budget, is intended as a ‘viable alternative’ to attending A&E for patients in Westminster. Practices are required to provide one GP, one nurse and one admin staff member during these sessions, with nurses paid £35/hour and admin staff £15/hour. The CCG says: ‘The programme is based on the success of a similar pilot using winter funding, which estimated a 31% reduction in A&E attendances and an 8.43% reduction of unregistered patients being redirected to this service.’

NHS North Durham CCG - has a scheme in place to increase access for patients to GP practices during weekends between 1 October 2013 and 31st March 2014.

NHS Lewisham CCG - Practices paid £100/hour for providing extra hours. It has to provide a GP and other practice staff to support the additional clinics/appointments e.g. reception staff.

NHS Waltham Forest CCG - commissioning the development of GP provider networks which it sees as a delivery model to transforming services and improving access.

Source: Pulse FOI request to CCGs in England

Readers' comments (9)

  • Peter Swinyard

    Oh good: In NHS Central London CCG, out of the £94/hour to open antisocial hours, "Practices are required to provide one GP, one nurse and one admin staff member during these sessions, with nurses paid £35/hour and admin staff £15/hour." I make that £44 an hour for the GP, other administrative costs, extra heat and light etc etc. Not to mention some good strong coffee. Please let me know where I can employ a good GP for <£40 per hour at antisocial times - a locum in sunny Swindon usually costs us between £600 and £850 for a day's work - in normal surgery hours. And who is looking at the malefits of the loss of continuity of care in providing this wants-not-needs service???

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  • As ever we stretch the elastic ever further. Surely time to re-think the delivery model and have sites that open extended hours and offer urgent primary care, rather than try and open every practice?

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  • It doesn't seem particularly well funded - out of hours never was. Looks like a loss making enterprise to me. The only way demand for extra services can be met would be to allow some form of co-payment. Even then, I seriously doubt we have enough doctors to staff it.

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  • Why do they have to find this out under Freedom of Information? Aren't we supposed to be part of the CCGs and fully involved in decision making?

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  • ha ha ha ha ha ha ha ha ha roflmao Anonymous | 30 October 2013 9:55am

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  • Arise Darzi Centre, you have been resurrected again!

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  • defunding of the OOH service has contributed much to the current crisis. now they want to fix it by underfunding it! what planet are they on?

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  • Extending your opening hours into evenings and weekends is not as straight forward as it may sound.

    If you own your surgery premises, there can sometimes be planning restrictions which prevent you from extending your hours within the law. Therefore, we would recommend that you always speak to your local planning authority before progressing this.

    If you lease your premises, your lease may state that you can only operate from the building within specific times. Therefore, if you were to extend your operating hours beyond this, you would be in breach of the terms of your lease. Therefore, you must make sure that you check your lease first.

    If your lease does contain covenants on the times that your doctors' surgery is allowed to be open, you will need to speak to your surveyor to establish whether there is any way around it. Your surveyor may be able to renegotiate these covenants with your landlord and agree an amended lease.

    http://www.gpsurveyors.co.uk/resources/ask_a_surveyor/opening_hours

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  • Is opening 6-8pm high quality ??? In Manchester the plan is for a single practice to cover all neighbouring practices staffed by a GP ( of some form) sharing the pt records.
    Do we want our patients seen by just anyone for their routine care - NO do our patients want to be seen by just anyone for their routine care -NO
    This will mean our records are completed by other doctors who may not follow our personally devised templates for Chronic care . As they have NO access to phlebotomy or indeed any lab services chronic care may be comprimised as patients attend but their bloods cannot be taken but they may then not attend again to the practice for tests. We have no Social services back-up . My guess is that this is a total committee driven "patch-up" which is not researched at all , does not have clear aims and is about as acceptable and workable as "dual registration". Please save us from Doctors and politicans that sit round tables but never undertake any proper brain storming to deal with issues . Manchester GPs do not want nor support this LMC secretary

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