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Networks to receive 45p per patient less through DES for providing extended hours

Exclusive The new network DES will pay £1.45 per patient for fulfilling the requirements of the extended hours DES - 45p less than practices currently get per patient, Pulse has learnt.

As part of the new contract, the extended hours DES will be scrapped and networks will be required to offer the same service as the current extended hours DES.

The funding for the DES will remain the same, but it will cover 100% of patients, as opposed to the 75.7% currently covered by the extended hours DES.

The BMA and NHS England point out that £30m has been added to the global sum  – which was increased by 92p per patient - to make up for this extra work needed to receive the total funding, and to help cover the requirement for NHS 111 to directly book appointments.

Speaking at events around the country on the new five-year GP contract, BMA GP Committee representatives revealed the payment per patient given to networks will be £1.45 per patient, as opposed to the £1.90 currently received by practices.

They added that it might lead to 'difficult conversations' between practices who offer extended hours and those that don't.

Pulse revealed last month that from July, the extended hours access DES will be transferred from practices to the new primary care networks, under the new GP contract.

This means there is no guarantee GP practices will continue to receive funding for the provision of the extended hours access DES, although NHS England and the BMA said they expect the networks to pass it on to the practices that provide the service.

Under the new contract, an average network with a population of 50,000 will be required to provide 25 hours extended access per week, which will be shared between morning, evening and weekends.

Networks will also be required to cover 100% of patients - including those of practices that are not part of a network – to receive the funding.

BMA GP Committee chair Dr Richard Vautrey told Pulse the new DES is not a reduction in funding as the difference is covered by the £30m added to the global sum, which also recognises the implementation of 111 direct booking.

He said: 'It is fundamentally untrue to say that funding has been reduced. In fact, it has increased. Practices will receive an additional £30m for the extra patients to be covered.

'When the transfer takes place to the networks, there’s £30m that’s been added to the global sum as a result of changes relating to the extending access DES and the NHS 111 appointments that practices will be providing. That’s the difference.'

He added: 'The DES currently funds the equivalence of 76% of the population so the expectation is the DES, going forward, will cover 100% of the population. To enable us to do that, £30m has been added to the amount. So the £87m that is currently spent on the DES is transferred to the primary care networks to deliver the extended access and the £30m has been added to cover the extra 25% patients that need to be covered.'

Speaking at the Londonwide LMCs’ annual conference on Wednesday, GPC executive team member Dr Krishna Kasaraneni told delegates practices that will be part of a network without providing extended hours might be asked by the practices delivering the service to financially chip in to help them cover all the patients in their area.

'The difficult conversation will be, I am not going to pretend it will be easy, where if in your networks two practices provide it and two practices don’t then what do you do? You have to get 100% coverage so that’s the conversation you need to have,' he said.

'[It’s has to be] as local as possible so if the other two practices can provide it, using the expanded workforce, great. If not, it may be that you have to come to an agreement saying “okay, I’ll provide for your patients but that payment comes through to you”.'

Dr Kasaraneni also said the 45p difference should not be seen as a reduction in funding.

He said: 'The payment will look like a difference because at the moment you get £1.90 per head for extended hours. A quarter of that has moved into the global sum so now the payment looks like it’s £1.45 but you have to look at the global sum and then it adds up.

'So the payment will remain the same. What we would expect the primary care networks to do is pass on that £1.45 [per patient] to you directly to continue to do what you’re doing now so this is not dismantling where practices are doing extended hours already at all. Where the practices are doing it, it just flows straight through.'

As reported by Pulse yesterday, some CCGs have been trying to 'manipulate' new primary care networks to ensure they align with their own plans.

Meanwhile, the BMA said last month that networks might not be able to recruit additional staff if inflation rises significantly as that pot of funding would be used to cover practices' increased core costs.

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Readers' comments (16)

  • Why should practice which doesn't provide the extended hour get that extra money whether it is 1.45 £ or the remaining 45 pr which BMA claims will come as increase in global sum? SO its unfair for practices who provide extended hours .

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  • Hang your heads in shame BMA. It's a complete scandal. More work for less money. Again.

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  • So this 92p pays for 2% pay rise for all staff, additional 1% pay rise for GP Partners, Funding for SARs, covers funding for transitioning to online services and now also 1/3 of Extended Hours. GPC should be ashamed. Am just waiting to see what else this will pay for. Wouldn't be surprised if they claim this also covers additional 6% Pension conts from next year

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  • I had to take a few minutes to get my head around all of these statements.
    What I think they are saying:

    1. As extended hours is only at 76% of the population then extending it to 100% with the same money will cut the rate from £1.90 per head to £1.45

    2. To compensate for this £30m is going into the global sum. This could have been added to extended hours to keep the rate at £1.90 but this was not done for some reason.

    3. That £30m also covers the 111 appointment booking. We are spending this twice.

    4. If you are in a network then 100% coverage is mandated (probably, yet to see the DES). If only some practices in your network provide the service they are likely to be miffed at only getting £1.45 and might ask for a bit of the other practices global sums, although that is also for 111. This will ensure networks start with bicking about money.

    5. If you are not part of a network pratices that are in a network will get £1.45 for extended hours for your patients. They are unlikely to be able to persuade you to chip in and you can keep your share of the £30m (about 45p/patient)

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  • SO what your saying is the global sum has actually NOT increased by 92p;
    it has infact increased by just 47p; with an extra 45p which is to be put towards extended hours.

    So giving practices an extra 47p/ patient; and expecting all staff to have a 2% payrise out of that is slightly concerning maths by all involved.

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  • There is nothing to stop a practice saying to the network - we can do it - but our price is £1.90 per patient. Then the network uses some of the £1.50 it has been given via the local CCG to fund the shortfall. Simples?

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  • How is anyone expected to run practices as businesses when the rules are so complex.

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  • Doing the maths - the 1.45 per patient is worth about £2k in my pocket a year after tax and pension etc. That is about £35 per extended hours surgery.

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  • Yes Fed Up ,worth it I think not wouldnt even put petrol in my car for a week.Pathetic contract BMA you have let us down.

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  • Cobblers

    This is needlessly complex and some of the arguments for are threadbare in the extreme. It is double if not triple counting a small amount "added to the Global Sum" and is a typical political method of saying you have been paid but in reality haven't.

    Now were I a refusenik I now know that to get ANY of the money 100% of the patients have to be covered. That gives me a tremendous leverage with the Network. It could amount to "Cover my patients for free" and we all get £1:45p but refuse and you lose everything and I lose nothing.

    Not that I would suggest any such. COI a refusenik but left in 2016.

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  • @fedup and turnout the lights.

    The reason the price per session seems so low, is that you think it is for GP sessions. In the current extended hours enhanced service, there is no stipulation for there to be ANY GP time.

    A 50000 GP network would need 25 hours a week for 1500 pounds per week (based on 3p a week, so a little higher than the actual figure.)
    60 pounds per hour is certainly not enough for GP time, but is more than enough for phlebotomist time.

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  • Knowledge is Porridge

    Could the extended hours DES be fulfilled by employing an additional HCA and nurse during improved access appointments?
    Or what about simply agreeing as network to not deliver extended hours?
    Not sure this is worth getting knickers in a twist.

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  • Once again, smoke and mirrors to make it unnecessarily complex. It looks like same money for 25% increase in workload. The BMA should be ashamed. GPs are seeing more complex patients now delayed by other healthcare professionals.

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  • EH is a deal breaker. 8-8, 7/7 is madness on steroids, and proof that the top down agenda trumps coal face efficacy and patient benefit

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  • I wonder is NHS really keen to have a OOH 111-like telephone support? This seems funded to about that level, (not clinical F2F!) but duplicating 111 or MIU seems pointless

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  • don't understand why anyone does them - i'd rather be at home cooking dinner, speaking to family or going out and having a life, but then again i stopped being a partner 4 years ago and have never looked back. what would happen if every one took the 30% GMS rise and then all refused to do the OOH. they would have to come back and offer more money to do it, cause they know no one else can do it as cheaply or as well. private companies are leaving the contracts in their droves because they make no profit. your a mug if you do it for 1.45, go for £5 per patient and negotiate down to £3.75 at most.

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