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GPs go forth

GPs need an extra £40 per patient to fund seven-day opening, says GP leader

GPs would need an extra £40 per head of population to be able to open their surgeries for longer during the week and at weekends, according to a GP commissioning leader.

President of the National Association of Primary Care Dr James Kingsland said that in order to allow all GP surgeries to open to patients from 8am to 8pm seven days a week the Government would need to move £2bn in NHS funding into primary care.

His own practice in Merseyside has recently taken part in a pilot with £30 per head of population non recurrent funding from Wirral CCG to ‘describe what a “never full” practice looks like’.

Dr Kingsland says that the evidence gathered from this work showed that an extra £15 was needed to offer patients extended hours during the week, £20 for the weekends and £5 to cover recruitment and administrative costs.

He told Pulse: ‘£40 per head of population would deliver a 12 hours a day seven days a week access to routine and urgent care.’

Earlier this month the Government set out plans to pilot longer practice hours seven days a week across nine sites covering 500,000 people with £50m of funding.

But Dr Kingsland is critical of the Government’s scheme saying that it was aimed at coming up with new ideas to a problem that has already been solved.

‘We should be building on the best that already exists in general practice, we used to open on Saturday mornings for a reason, all of that knowledge and expertise in demand management is all there in good general practice, this money should be used to build on that,’ he said.

He said that if an additional 2% of funding was moved into general practice then less money would be needed to fund A&E and that walk-in centres would become redundant.

Readers' comments (21)

  • There will never be enough money to fund what is wanted . If the NHS is to remain state funded pehaps we should concentrate on what is needed

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  • Richard. Wish I could say above so well in only 2 sentences. What they want (patients and ministers) very different to what is needed.

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  • "£5 to cover recruitment and administrative costs"

    Fair enough - but where are the extra doctors that will be needed for every practice going to come from and if locums are used what good will that do for continuity of care?

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  • Ivan Benett

    May I once more add some light, hopefully, to the conversation. There are two separate but linked issues around access - 1. more availability by increasing opening hours, and 2. ensuring timely responsiveness.

    Responsiveness means the time it takes for a practice responds to an expressed need from patients or their carers. It is important to be able to let our population know what standards of responsiveness they can expect from their practice. I believe we should be able to match the in-hours standards with those that they currently receive from contracted out-of-hours services. These have been Nationally agreed and work.
    That is to say, they can expect a call within 60 minutes of contact with the practice, from a clinician who will make a clinical assessment, usually by telephone. If the caller asks for an urgent call then the response should be in 20 minutes as is currently usual practice, and is required only rarely. The clinician could be a nurse or a GP. At the triage an assessment can be made of the clinical need and urgency of the problem. A face to face appointment can be made within the appropriate timescale. The outcomes could be that the problem is managed there and then, over by telephone (or skype in the future); an ambulance is called for an emergency; an appointment made within 2 hours for a problem assessed as urgent, or within 6 hours for a problem assessed as a 'same-day' problem. Some may simply prefer a later appointment which can be managed by a receptionist, as happens now.

    Most practices already reach this standard most of the time. So it will be a matter of demonstrating that all practices offer that same standard.

    Practices can be incentived through a quality premium if they can demonstrate that they reach these standards. Which thresholds we use and the value of the quality premium for this can be determined locally. I would hope that in this way practices will be rewarded for their achievment and at the same time the public will be able to have data on the responsiveness of their practice. Improvement trajectories can be if necessary. This is the improvement methodology that we set for the hospital sector through CQUINs.

    In terms of opening hours, these can be commissioned from the GP provider organisation. Models would vary depending on what suits your locality. The commissioning outcome is that people registered with a practice will able to access that practice or a nearby practice 8am to 8pm during the week, and for three hours on Saturdays and Sundays. For this to work neighbouring practices will need IT access to the patient notes, after appropriate consent is provided. NOT ALL PRACTICES NEED TO BE OPEN BEYOND THIER EXISTING HOURS nor GPs work more than they want to. Therefore we will eed extra capacity, this is accepted and can be planned and paid for.

    That's the model. How it's paid for is a different this space, but please don't dismiss out of hand and think about the oportunities.

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  • pilot worth £50,000,000 to cover 500,000 patients = £500/per patient. who is wasting NHS money!!!!!!

    Am i right? cannot believe my calculating skills or should Jeremy Hunt answer the above waste of resources

    GPs piloting this will be very happy.

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  • Peter Swinyard

    The pilot of course is NOT NEW MONEY and will be nicked from existing patient care to satisfy a political whim....."we need to announce something about the NHS at the conference. This is something. So we will announce it"
    The Darzi centres, a londoncentric answer to a metropolitan problem, are being decommissioned in many places as not value for money. Why oh why are we reinventing failed policies?

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  • Ivan Benett

    Not at all right and it may be good to hear about all the nine projects within our demonstrator site bid. Access form part of the whole, but an essential first part of the jigsaw, around which all else fits. Our projects include better identification and management of longterm conditones, including dementia: work to improving acces for homeless, and people in care homes. In reach to manage the discharge process better, roling out enhanced management of heart failure and diabetes.
    So for £500,000 we're aiming to do more than just access. I ope this brief notehelps but really needs a more detailed article

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  • Ivan Benett

    Of course there's no new money! Have you not seen the economic state the country is in. The money needs to be taken out of secondary care activity. Think creatively, but it needs to end up in Primary care if we can show we can manage the activity. I believe we can, and that this is the opportunity to develop Primary care. This will be seen as the age of Primary are. The pilots are aimed to show whether I'm right. We shall see. if anyone has a better answer, happy to hear, but YES, no new money!

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  • >The pilots are aimed to show whether I'm right.

    There is a huge amount of evidence to show that government completely ignores the results of pilots (SCR, 111 etc) and presses on regardless when it suits their agenda.

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  • May I ask the practices who have agreed to pilot 8am-8pm access and 7days a week to give some sort of idea on how much £/pt extra are they gaining from it?
    Ivan Bennett above have tried to explain the other extras they are doing: some of which does sound above what a regular GP practice may do. He stated that its for £500000. whats the population size you serve?

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