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A faulty production line

PCTs get tough on GPs' in-hours closing

By Steve Nowottny

Exclusive: NHS managers are waging a nationwide campaign to stop GP practices closing at lunch time or for half-days, a Pulse investigation reveals.

More than half of PCTs have already begun action, or have drawn up plans to do so, to clamp down on surgeries that close during the day. Some trusts are issuing contractual threats or employing mystery shoppers to expose GPs.

But the GPC warned the moves could damage the ability of GPs to train staff and would leave small practices overstretched and with little time to do paperwork.

A Pulse survey of 79 PCTs using the Freedom of Information Act reveals the Government's extended hours drive has prompted serious scrutiny of in-hours closing. Hundreds of practices have been pressured to change their opening times since the Department of Health warned in January 2008 that closing during the day would ‘negate against' GPs claiming incentives for extended opening.

Among PCTs with figures for 2008 and 2009, the proportion of practices closing in-hours dropped from 62% to 56% overall, but much more dramatically in areas that have already taken action on the issue.

In North-East Lincolnshire, the proportion closing for a half-day fell from 65% to 21%, and in Knowsley just eight practices now close for a half-day, compared with 17 last February.

Under the GP contract, practices are responsible for patient care from 8am to 6.30pm, but can choose their opening times. But many PCTs are following DH advice to make extended hours incentives conditional on opening throughout the week.

Managers are employing both the carrot and the stick to improve patient access. NHS Hull is to ‘mark' practices on opening hours on balanced scorecards, and Lewisham PCT is preparing an audit of opening hours from next month.

In Newham, where 98% of practices close for at least one half-day, in-hours closing will be the focus of an imminent PMS contract review.

NHS Derbyshire County is among those PCTs employing mystery shopping techniques, with staff calling round surgeries after 5pm to check that they are still open.

But Dr John Grenville, secretary of Derbyshire LMC, said practices were under no obligation to yield to PCT pressure: ‘The PCT is getting a lot of pressure from the Government. Its view is the wording of the contract means all practices should have their doors open from 8am to 6.30pm. It has made it clear it expects practices to be open – we've made it clear we don't.'

But in other areas, such as Liverpool and Leicester, GP leaders said large reductions in in-hours closing followed additional resources from their PCT.

Dr Gethin Jenkins, secretary of Leicestershire LMC, said: ‘The PCT has put together a very generous extended hours LES and as part of this insisted practices open in the afternoon. It is a reasonable quid pro quo.'

Dr Peter Holden, GPC negotiator, warned of the effects on small practices: ‘PCTs are trying hard to hammer small practices and it's most unfair.'

How PCTs are tackling in-hours closing

Some 43% of PCTs are already using at least one of these methods to reduce in-hours closures, and a further 13% will do so shortly:

Extended hours Many trusts have made extended hours incentives conditional on limiting in-hours closures, or even stopping them entirely

PMS reviews Opening hours will figure prominently in the next round of PMS reviews, with some areas planning to make opening 52.5 core hours a week compulsory

Local incentives Some trusts are offering extra funding to prevent in-hours closures, either through
a modified extended hours LES or a dedicated access LES

Mystery shoppers Some trusts have begun calling round practices at lunch time and in the late afternoon to ensure compliance

PCTs are clamping down on closing at lunchtimes and for half days PCTs are clamping down on closing at lunchtimes and for half days

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