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GPs go forth

Every CCG to get £6 per patient to extend GP access from 2019

All CCGs will be expected to extend GP access on evenings for an extra £6 per patient from April 2019, but weekend opening will 'depend on local demand', NHS England has said.

In the first detailed account of how NHS England will fulfil the Government's mandate of weekend and evening access to general practice, it said total recurrent funding would reach £138m by 2017/18 and £258m by 2018/19.

NHS England explained to Pulse that CCGs would have to commission at least an extra hour and a half of evening appointments, while Saturday and Sunday opening would be flexible depending on local demand.

It comes as the GP Forward View pledged that by 2020/21, over £500m in additional funding annually would enable CCGs to commission 'access to GP services, including sufficient routine appointments at evenings and weekends to meet locally determined demand, alongside effective access to out of hours and urgent care services'.

Today's announcement said 'this will contribute to the overall ambition of investing an extra £2.4bn in general practice services by 2020/21' that was pledged in the GP Forward View.

As previously revealed by Pulse, the funding of £6 per head of population will be made available to GP Access Fund (formerly known as Prime Minister's Challenge Fund) pilot sites during this financial year. NHS England said this would extend to 'a number of additional areas across the country' in 2017/18.

It said the money would also fund an extended access programme covering the whole of London starting this year.

In today's announcement, NHS England said that 'the investment will be extended in 2018/19 to enable the whole country to start developing additional capacity, so that from April 2019 every CCG can expect a minimum additional £6 per head to improve access to general practice'.

The planning guidance document said that it is a 'must do' for CCGs to 'extend and improve access in line with requirements for new national funding' by no later than March 2019.

The document also sets out that by 2018/19, CCGs have to 'ensure' the sustainability of general practice by implementing the GP Forward View - including plans to extend capacity in practices, increasing the number of GPs, co-funding pharmacists to work in general practice, expanding IAPT with more primary care-based theraists, investing in training practice staff, extending online consultations, supporting GP practices to work at scale as MCPs or PACS and 'enable and fund' primary care to 'play its full part' in implementing 'the forthcoming framework for improving health in care homes'.

Dr Arvind Madan, NHS England’s director of primary care, said: 'We know that general practice is under pressure and we are determined to maintain the momentum in turning things around, as started with the launch of the General Practice Forward View.

'Today’s planning guidance, with detail on how investment will look in the coming years, demonstrates the steps we will be taking with CCGs to both stabilise and transform GP services in the years to come, for the benefit of staff and patients.'

GPC deputy chair Dr Richard Vautrey said: 'It appears that NHS England have learnt from the lessons of many of the pilots which showed that there was little demand from patients for routine weekend appointments. There is importantly now no requirement to be open 8-8 on Saturdays and Sundays, with flexibility based on local needs.

'It is sensible that extended hours appointments will also be available for urgent appointments.

But he added that the £6 per patient recurrent funding was 'considerably less' than many of the GP Access Fund pilot areas have received to date.

He said: 'They will now need to cut their cloth according to this reduction in funding. With a shortage of GPs and reduced funding they will also have to consider using other health professionals to provide these appointments.

'In addition we would expect CCGs to work with GPs to integrate current out of hours and urgent care services to avoid duplication and make best use of the available resource.'

Dr Vautrey also welcomed the planning guidance mandating CCGs to ensure the GP Forward View measures are implemented.

He said: 'This is vital at a time when general practice is overwhelmed by unsustainable workload pressures leading to GP burnout and practice closures.'

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Readers' comments (45)

  • I would not like to be seen at 7.30 pm by a GP who had been working since 8pm. There is a limit to endurance. We may be doctors, but we are also human beings who need to have time for our families too .

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  • One word two letters NO

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  • I can't see my financial advisor outside Monday to Friday 0900-1700 He can't even phone me to arrange a meeting because of "work-life balance issues"
    I can't see my accountant outside Monday to Friday and the wait is 10 days.
    My optician has come down to 10 working days, My dentist is 2 weeks and that is a family favour and the car which conveys me to medical emergencies has to wait 2 weeks for a service



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  • Average GP practice - 7k patients, so this is worth £42k/year to them.
    Increase of 396 hours during the week, plus weekend work as well. Let's assume 4hrs per weekend day, gives us another 416. Total - 812hrs.

    That gives you £51.72/hr. Even assuming there were enough GPs out there to fill these extra hours (there aren't) and that they were willing to work them (they aren't) and that it wouldn't leave OoHs with no cover at all overnight(psshhh!), this will not cover the cost of a GP, the reception and office staff to support them, and non-pay costs which will scale with additional opening hours. So its a pay cut, a danger by spreading existing staff thinner, and a politically driven nonsense.

    Oh, by the way, with 4 partners, I have at least 2 who have previously said they will quit if this is imposed. I look forward to being 2 down by the end of the day. FFS.

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  • Ashley Liston

    Extended access and improved access are related, but very different. With a diminishing and increasingly tired GP workforce extending GP opening hours does not seem wise or in the spirit of GPFV. It is possible to improve access and reduce pressure on GPs but it needs GPs to re-imagine traditional appointment systems and skilled change management. GPs need to be given the head space and have the will to do this. Extending working hours is not likely to help.

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  • The Prime Minister lost his challenge due to arrogance and overestimation of his ideology over common sense. The 'Challenge' however continues to haunt general practice. On two days a week, we leave our Practice just before 7 pm having done extended hours from 7 am ie almost 12 hour shifts. Can we do more than this physically or mentally without putting patients at risk? I don't think so. People implementing these ideas are psychopaths and should be treated as such. Stuff your money and let patients and doctors be safe.

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  • Practice Manager at 6:11 am, 100% agree and the fact that you are looking at this at 6:11 am tells its own story!

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  • Practice Manager at 06.11 - I totally agree AND that assumes that the £6 is the full payment to the practice without the CCG's top-slicing the funding.

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  • The key element of this 'consider using other health professionals'.

    In other words, we want it on the cheap. We want you to run your practices like OoHs, with a lot of HCAs, nurses, AHPs and the odd GP supervising like a consultant. These folks just don't get it at all.

    The reason general practice is so cost effective is that it uses the most skilled clinician up front to ensure the best outcome. If hospitals did less things on the cheap we would increase throughput by 30% (see the BMJ article on Liverpool Hospital with twice daily consultant ward rounds) and flat line costs, which would make the whole system flow.

    NHSE know the cost of everything and the value of nothing. Its why they spend their money in the wrong place currently, and will continue to do so in the future. Pay cheap, pay twice.

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  • So lets reject the extra hours for £6 and charge £70 per appointment in Uber Dr style if we really want to at least financially compensate for the loss of family/social life

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