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Gold, incentives and meh

Extended access pulls GPs away from surgeries, finds partnership review

Extended access services are enticing GPs away from practices, as the work is 'easier', the chair of the Government’s GP partnership review has said.

Independent chair Dr Nigel Watson told Pulse in some areas GPs are reducing their surgery hours to work for extended access services, due to the attractive pay and workload.

The final report from the partnership review, published today, said primary care networks – which practices will be mandated to join in return for the financial boost pledged by the Government in the NHS long-term plan – should be given the extended access funding to allow local decision-makers to manage the 'demand appropriately’.

Speaking to Pulse, Dr Watson said: ‘In some places they have commissioned [extended access] through groups of practices working together and third party providers.

'Largely those providers have paid GPs - to attract GPs for a three or four-hour session - a fairly significant sum per hour. There’s no paperwork largely. There are fixed numbers of appointments in a fixed timescale.'

He added: ‘What’s happening in some areas is GPs are saying that work is easier than being in the practice and pays better so I’ll cut my sessions in the practice to work over there.’

Among its 23 recommendations, the partnership review said the funding for extended access appointments should be channelled through primary care networks in the future. 

The review, published today, said: ‘Primary care networks should be enabled to determine how best to address the balance between urgent and routine appointments during extended opening hours and weekends.

‘Extended access services in many areas are attracting GPs away from practices.

'NHS England should therefore consider how existing funding for extended access and opening could be allocated through primary care networks as they mature, to enable local decision making on managing demand appropriately.'

This could 'reduce fragmentation of services' and 'improve continuity of care', it added. 

The Government is providing funding of £6 per head for its extended access scheme in 2019-20, which Dr Watson said represented ‘significant sums of money'. 

This comes as health secretary Matt Hancock told Pulse some of the £4.5bn funding boost promised to primary care, as part of the £20.5bn NHS funding increase, will be used to relieve pressure on GPs.

Researchers previously reported patients generally value GP quality over extended access, with the attention and communication they receive from their GP being the most influential factor on their experience of general practice.

A recent investigation by Pulse found a quarter of evening and weekend appointments were being left unfilled as the policy began to be rolled out nationally across England.

Key recommendations from the report

1. There are significant opportunities that should be taken forward to reduce the personal risk and unlimited liability currently associated with GP partnerships.

2. The number of general practitioners who work in practices, and in roles that support the delivery of direct patient care, should be increased and funded.

3. The capacity and range of healthcare professionals available to support patients in the community should be increased, through services embedded in partnership with general practice.

4. Medical training should be refocused to increase the time spent in general practice, to develop a better understanding of the strengths and opportunities of primary care partnerships and how they fit into the wider health system.

5. Primary Care Networks (PCNs) should be established and should operate in a way that makes constituent practices more sustainable and enables partners to address workload and safe working capacity, while continuing to support continuity of high quality, personalised, holistic care.

6. General practice must have a strong, consistent and fully representative voice at system level.

7. There are opportunities that should be taken to enable practices to use resources more efficiently by ensuring access to both essential IT equipment and innovative digital services.

 

Source: GP Partnership Review

Readers' comments (17)

  • THIS IS TRUE....

    SOME WORK IN HUBS FOR £80 PER HOUR FOR 15 MINUTE CONSULTATIONS, NO PAPERWORK, NO REFERRALS AND TELL EVERYONE TO "SEE THEIR OWN GP"-AN EASY RIDE.

    THIS PROVIDES "CRAP" VALUE FOR MONEY FOR THE TAXPAYER COMPARED TO SALARIED GPs AND PARTNERS IN GP PRACTICES WHO EARN LESS THAN HALF THIS HOURLY RATE, WORK 12 HOUR DAYS AND HAVE MASSIVE RESPONSIBILITY AND STRESS.

    I CAN ONLY ASSUME THAT THE GOVERNMENT HAS SOME "SPECIAL BUSINESS" RELATIONSHIP WITH THOSE RUNNING THE HUBS WHO HAVE MANAGED TO PERSUADE THEM TO OVERFUND GP HUBS WHILE FURTHER UNDERFUNDING REGULAR GP PRACTICES. IT IS LIKE SOME SICK JOKE-THEY ARE PUTTING IN ALL THE RIGHT MONEY JUST INTO THE WRONG HANDS.

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  • Let common sense prevail

    I wonder why none of us anticipated this happening when Govt threw money at extended access???
    It ain't rocket science!

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  • The DoH and the civil service that advise them are definitely not the sharpest knives in the box when it come to market economics and evidence based policy decisions.

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  • If I keep saying it, maybe some of it will stick. This is what you get with centralised socialised state regulated comprehensive healthcare provision...
    It's always easier to spend someone else's money.
    Ivan will say it's great. He'd even allocate more money for homeopathy and placebos

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  • This is what you get with centralised socialised state regulated comprehensive healthcare provision when a bunch of capitalist arseholes run it into the ground so that they can sell it off to their rich pals and enjoy the kickbacks.

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  • If the public ends up being better off for having to grow up and deal with more responsibility, and choosing to go with a smaller state, who cares if a bunch of people earn from the process?

    The lesson here is don't let the state get involved in the first place. How's the healthcare doing over there in North Korea or Venezuela, Angus?

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  • ..and if the public ends up worse off for politicians abrogating responsibility for everyone (including those who can't afford heathcare or those who actually can't take responsibility for themselves) and choosing to go with a smaller state then who actually cares if a bunch of people die in the process?
    You're right. This is not North Korea or Venezuela, but perhaps more disturbingly it is the 6th richest nation on Earth with some of the widest inequalities. I can clearly see that your solution is just to widen the gap. That will help.

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  • Angus, I've pointed out before, you clearly don't know your history or economics. Its not a zero sum game. the smaller the state, the higher the absolute poverty line. That's what those who purport to be for the working class should focus on. Relative inequality means nothing. There's a bigger inequality between Bill Gates and the average person, than the average person with the poorest. But Bill Gates owes the average person nothing. Now I'm not for complete 100% individual responsibility, I'm for consideration of minimal emergency treatment and maybe access to primary care universally, but nothing else with regards to healthcare. I've pointed out to others too, that if you want to help the less fortunate, by all means do so, as have I the right to choose. But I'm not for compelling through the use of force/law everyone else to do so too. Because in having to regulate the process, everyone suffers. And in North Korea/Venezuela, there is less inequality because everyone has nothing. In your socialist utopia, that would be ideal wouldn't it?
    Socialism fails when you run out of others' money to spend. And we have, running up a bigger debt every year. We're only the "6th richest", due to the size of the economy, inflated by increasing borrowing, and because not many others are doing as well. But we may soon be superceded by many growing economies. Keep on this path, and we risk becoming a Venezuela. You don't think it might happen? Look at our shambles of a police force, enforcing thought and speech 'crime'. God forbid, Corbyn and John McDonnell ever get in power.

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  • doing salaried work at moment but pension payments are not being acknowledged by capita/ pcse since 2017. the only reason i became salaried was for the pension and NI. if i am not going to get these its actually not worth the low pay compared to locum work. plus i can work when i want rather than having to miss events because some one else booked that day off first. all in all every thing is driving me away from salaried work in a GP practice back towards being a full time locum. will never be a partner again, too stressful and long hours. if GP paid locum rates plus pension and NI doctors would come back to practices - which is the amount GPs should have been paid in the first place. But we live in a capitalist society and this is the price you pay for free choice. Doctors and nurses are not stupid, they will go where the money is, here or abroad.



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  • dvader, why do you think partners are being underpaid compared to globally? because the health service is socialised and state regulated. And we are not being allowed to be subjected to free market forces. Yes our private sector is capitalist, but 'British' society has clearly leaned way over to the left, when

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  • ...less than 50% of the population pays for everything and everyone else, and our debt grows. Anyone has any idea what this proportion is over in the capitalist economies of the East? With less socialist policies like healthcare and welfare, according to Angus, they must be dropping like flies.... Oh wait...

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  • Knowledge is Porridge

    We are doing improved access through our GP network, shared rota of practices. Working well. Partners are volunteering as paid well. Locums are missing out on attractive work by not being partners. This is good for partnerships in my patch, which in turn is good for the long term future of GP care. Who'd have thought more money helps!!

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  • I do occasionally agree with you Christopher.
    'If I keep saying it then some of it may stick'
    Shit does actually stick.

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  • Tantalus

    It is relatively easy to get piecemeal work at £80 an hour with no responsibilities, stress or red tape. Being a partner has all of the above for about half that hourly rate.
    It’s not difficult to see why portfolio and locum careers are more popular.
    It also explains the exodus to Australia, New Zealand and Canada.

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  • Haha Angus, you're being the typecast leftist. Lose the argument, so try and sound smart with an empty soundbite. And Porridge, unsurprisingly, valuing Partners closer to their proper market value helps to keep them. But you're not looking at the bigger picture, having the government regulate even better pay for GPs, harms everyone.

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  • With respect many here have the wrong end of the stick, 15 minutes in EHS allows one to both enjoy medicine, take a better history/listen better,etc!

    As it should be.

    So yes extended hours deserve the rate they get, and perhaps more, but its the partners who then should lobby for better pay!

    consider this,plumber rate OOH £100/hr

    Alas, sometimes i despair for the fraternity when you cant see the woods for the trees! Do you think one may suffer from the Stockholm syndrome?

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  • Everyone knows EH is for minors (little or no admission impact). In addition it means the limited GP capacity is not there during week-day hours when MDT and CHT and admin is present to do chronic illness management. So EH is harmful to admissions impact. But EH is a popular thing with the working-well voters....

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