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Independents' Day

GPs to open until 8pm every day under £50m 'pioneer' programme

Groups of GPs in nine areas will be paid to open until 8pm every day - including weekends - under a Government scheme to boost access to practices that it intends to roll out across the country.

The nine trial areas will also test out a variety of ‘forward-thinking services’ for patients, such as greater use of Skype, email and phone consultations to further boost access to GPs through a £50m ‘challenge fund’.

The Government said the pioneer scheme will launch in 2014/15, with a view to rolling out the scheme across England if the trial is successful in reducing pressure on hospital services.

It comes as CQC chief inspector Professor Steve Field confirmed comments made over the weekend that he would be looking for ‘brilliant access’ when he is inspecting GP practices.

What groups of practices will be expected to provide:

  • Access 8am-8pm, including Saturday and Sunday
  • Flexible access including email, Skype and phone consultations for those who might prefer it to face-to-face, when it is safe to do so
  • Electronic prescriptions and online booking of appointments
  • Easier, online registration and choice of practice
  • Joined up services with urgent care and out-of-hours care to ensure rapid walk-in access to care
  • Greater flexibility about how people access general practice, for instance with the option to visit a number of GP surgery sites in their area
  • Better access to ‘telecare’ to help sick people stay comfortable at home, as well as to healthy living apps

Source: Department of Health

The extended-hours scheme is already due to be trialed in practices in Manchester.

Prime Minister David Cameron said: ‘Millions of people find it hard to get an appointment to see their GP at a time that fits in with their work and family life. We want to support GPs to modernise their services so they can see patients from 8am to 8pm, seven days a week.’

‘We also want greater flexibility, so people can speak to their family doctor on the phone, send them an email or even speak to them on Skype.’

He told BBC Breakfast that he was aware that GPs work very hard, but that the move was required to reduce the pressure on A&E departments.

He said: ‘I live next door to a GP in my consistuency - I know how hard they work.’

Health secretary Jeremy Hunt said: ‘We live in a 24/7 society, and we need GPs to find new ways of working so they can offer appointments at times that suit hard-working people. Cutting-edge GP practices here in Manchester are leading the way, and we want many more patients across the country to benefit.’

Professor Field added: ‘This move towards seven day services is great news for patients, and should be embraced by GPs. I want to see brilliant access to GP services for patients across the country, and will be assessing this in each practice I inspect.’

National Association of Primary Care chair Dr Charles Alessi said: ‘This is an opportunity for practices to change the way they work. In other words, to be able to improve access on a seven-day-a-week basis. It is a chance to experiment with new ways of working in their patient populations.’

‘Of course it is a good idea and it is not just for general practice. It would really be a lost opportunity if only general practice moved to seven-day working and we still had other parts of the NHS which were working five days a week. This is about a whole change to the way we work, and general practice is part of that.’

But outgoing RCGP chair Dr Clare Gerada warned the Government of putting political priorities ahead of patients’ needs.

She said: ‘I think this was part of the 2008 Labour party policy, with the Darzi centres. Many of the walk-in clinics and Darzi centres are being shut down because of resources, but to me it is just a continuation of that policy.’

‘My worry is you have to choose between access, affordability and continuity. You can’t have all three, and what we desperately need at the moment is not access but continuity because that is how we improve the lives of our patients with long term conditions.’

‘In the ideal world, yes of course it would be great to have 8am to 8pm, 365 days-a-year opening. But we are not in the ideal world, we are 10,000 GPs short and GPs are at the lowest of their ebbs since I can ever remember. We need a joined up strategy akin to RCGP’s 2022 vision for general practices, not piecemeal announcements that I suspect are directed at, dare I say, the “voting classes”.’

GPC deputy chair Dr Richard Vautrey added: ‘I think it is important here to delve beneath the headlines. These are pilots and they are being paid for, and it shows that general practice can do more if the resources are provided for us to do that.’

‘We would like for more GPs to offer [increased access] but we can’t do, it would be a disaster, because it would mean spreading the service even more thinly. If we expect GPs who are already working 53+ hours a week to work 84 hours a week then that will reduce the quality of the service and decrease patient satisfaction, because they will not be able to see their regular GP when they want to see them.’

‘It is essential that we see an increase in investment in general practice, so that we can employ and take on more GPs, expand our practices and work together, but this announcement is really about almost reinventing GP co-ops, and that sounds very much like Groundhog Day.’

This story was corrected on 9 October after it emerged that the extended hours pilot the Government had praised as ‘successful’ will not begin seeing patients until Christmas. Read the full story here.

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Readers' comments (77)

  • GPC/BMA-We are expecting a prompt response over this.One that represents the majority of your member GP,s , rather than the RCGP stance of representing a few private GP s based around Westminster, or looking to make some money at the pilot sites.

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  • A 40% increase in working hours should be met with (at least) a 40% increase in doctors and funding if current services are to be maintained. Surely this should be self evident?

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  • "But outgoing RCGP chair Dr Clare Gerada warned the Government of putting political priorities ahead of patients’ needs."

    She's got the nerve!

    But really Mr Cameron? If you truely want to "help" GPs modernize their service, how about a realistic evaluation of the cost benefit of the service and funding that follows it to make it achievable?

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  • And who will be inspecting the Chief Inspector's practice to ensure such brilliant access is being provided?

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  • Isn't that called an OOH service if not provided by your own GP?

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  • ?Spread the jam thinner soonit will taste of nothing

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  • This will just get worse and worse. Do what I did and leave the UK. Make the leap, it's not as scary as you think.

    Also note for our younger colleagues AVOID GENERAL PRACTICE LIKE THE PLAGUE.

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  • "The extended-hours scheme is already being trialed in six practices in Manchester, with the Government hailing their experience as ‘successful’." Strange that there was no comment from the practices themselves - do they feel that the experience was/is "successful"?

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  • * slow hand clap* And presumably we weill be hearing the announcement in the next few days of tescoburys opening their "doc while you shop" facility.
    Utterly ridiculous.
    I'd love to know where the funding for this will come from after the "chosen few" decide that its fabulous as they made out like bandits and then drop the rest of us well and truly in it as we will be expected to provide this within existing funding

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  • SO, he knows that GPs work hard and he wants to make it even harder for them....not to mention the very hardworking Receptionist. How do GPs take theim se;ves/their children/their dependants to the Doctors/toi the dentist etcetera. Why is he condeming the GPs to working at weekends when he is not making consultants.....there lies the problem with A & E! I couldn't get a death certificate from A & E "because it's a Friday and there aren't many Doctors on on a Friday" and so says a Sister at a centre of Excellence!!! Cameron is looking to make GPs scapegoats for Consultants!

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  • Said it before and i will say it again, happy i live in a country where the government has more sense

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  • I have finally decided, with heavy heart, that my practice is unviable. With one full-timer and two part-timers, we cannot provide 7 day/week cover.
    Having made that decision, I'm almost relieved.
    Have enough savings to last 6 months - enough time to enjoy my family, and wait to see what's left of general practice by the end of it.

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  • having looked at the chief inspector of gps prsctice website I see it says they are closed at weekends!

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  • I would not be interested if they gave me the whole £50 million.....I am not doing it, ever. I would rather be waterboarded daily. Would you sell your children for £50 million??? That is how i feel about this.

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  • Thinking abou this in the shower and on the drive here- theres only one way for this to work -
    As it is for groups of practices: ie federated practices , providing the services , from 1830 pm and on weekends 7 days a week, outside of current hours.
    I think I`ll call it an Out of Hours service.
    And the acronym iS OOH- which is what I said when I made that leap.

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  • This is not as scary as it sounds - It is an opportunity! Take that opportunity, revaluate your priorities, decide what you want as a work/life balance for the next 30years. If 8-8 7 days a week is not good for you something about it. Resign, retire,go part-time but decide quickly so that HMG/DOH no how angry you are and how out of touch they are! Vote tactically in elections, it is time for GP's to make a stand! Do it now!

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  • I am astounded that the government can close down current 8to8 services around the country and yet say we need to have 8to8 services! Contradiction!!

    Why not talk to the current providers of 7day a week 8 to 8 services who have been running them for 5 years and see what the issues are - I think you might find that a LACK OF GPs is the major issue - So Mr Cameron are you going to find more GPs for this 'new scheme'

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  • Thank God I retire in January

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  • have now decide to retire in Apr 14 - Good luck to you all

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  • The sooner General Practice becomes a salaried service the better

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  • Treating hypertension on Sunday at 2pm is bound to reduce A&E attendance. At least Downton starts at 9pm.

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  • 24/7 doesn't apply fully to supermarkets or banks- no butchers, fishmongers, bakery or face to face with bank tillers.
    funding, staffing- mere drop in the ocean for the politicians- it's electioneering pure & simple from people who really have no concept of Primary Care outside the leafy suburbs

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  • its fine to talk about convenience of the patients, their working lives and families. how about the the same thought be given for GP's and doctors in general - they have a right to family life too right?

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  • Peter Swinyard

    Did you know that we do not have a coalition government but a Green government? This is a recycled policy using recycled money. The £50m thrown at the "problem" is money at present being used for treating patients. How does that improve health care? The policy of having an 8-8 surgery in every area is a recycled policy. We all have Darzi centres, where they still survive.
    No, we all know this is crazy, we all know this is electioneering but it is a populist policy which can have no legs in an environment where the workforce is flagging and looking for the exit and where the patients ask at their peril for 12 hour 7 day general practice - they will lose the vital continuity as expressed by Claire Gerada in your article.
    This is time for general practice to say no. But we have to put our own houses in order and provide good access in our present hours - not easy with such overwhelming demand and a shrinking workforce.

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  • I think it's good idea.many GPs abuse public money to send their own children to private school but pay their staffs peanuts. Wife is employed as manager/adminstrator in paper with handsome pay.keep family members including children in practice payroll to avoid paying due taxes.patients access is poor as GP has no time to see patient as he is busy keeping his COF updated and on top .I as salaried GP struggle to keep family's necessary needs although I am the one who runs the clinic and work hard.
    So, it's time now that GP should stop abusing public money and look after the patients what you are paid for.

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  • I don;t think the policy is that all GPs have to work 8-8 7 days a week!

    Just those that are large/flexible enough to offer the service. If you increase capacity then yes, you should get paid for it.

    Many saying that this will push them to retirement. The government will have to hope that the next generation of GPs coming through are more open to their ideas, as without them it will not work.

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  • A long time ago I was a registered patient with Prof Steve Field's practice. You could never get an appointment with a partner - only with one of the trainees or registrars. Perhaps it is OK to preach for others to work harder, when you don't have to do it yourself ...

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  • I ALWAYS BELIEVED gp should be available 7 days a week.. once a good financial return for extended hours become available, gp's can employ others who want extra money. small practices or single handed will need significant finance to pay gp's and staff. if it is not funded well ,it is a non starter. no one runs business in loss. in old days even single handed gp was available round the clock for tiny amount of money. now is time to pay then properly for extended hours. PAY GOOD MONEY AND ALL WILL BE FINE.

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  • If less GPs around during "ordinary hours " this will mean less GPs to deal with acutes..more admissions. Most A/E attendance is between 8am and 6pm anyway ( 80 % ? ) ..so this will exacerbate.
    Patients will be asked to appointments in the dark ( not favoured by elderly ).

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  • Dear Mr Kabir 10 04
    It is quite apparent that you have some type of personal agenda and axe to grind. Likley with your current employers. I think that such comments are disgraceful and not professional

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  • Hazel Drury

    Was it just me or did I hear on Today that Mr. Cameron said there were increases in the number of doctors to cope with this?? Really?

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  • This is fine because my staff have all said they will come in on the weekend for no extra money!

    We only have one cleaner for our small surgery but she will now work seven days a week for the same wage!

    One of my partners cannot help out as he goes away on weekends. The other works on the OOH on two shifts plus extra training hours.

    I do not care as I have no life and would like to do something on the weekend.

    All is well in the best of all possible health systems. .

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  • Naturally we will have full access to all hospital facilities during these periodsie bloods, microbiology, ultrasound XRay, physio, OT since as GPs we are part of a team not workers in isolation.

    What was that Prof? No? Why not Prof? Whilst you are answering that one please tell us how many hours a day a GP Should work ? How many hours a week? How many patient contacts?

    I am sure such a wise academic GP should inform us lesser mortals who actually do the work if the answers to such boring questions.

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  • So GPs will just bend over and take it, just like they have always done. Too many in this profession are wet cloths and not prepared to properly fight together for the resources we need.

    Strike anyone? No hands at all? No, I thought not....

    Sooner I can get out into private work the better. The life of a GP STINKS now.

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  • Most of us are looking at this from a GP partner perspective. Other GPs look at things from a commercial perspective. Corporately if I could hire few GPs to run the services then I might just about make it pay. This does not open access to good continuity of care with their "named" GP, but ticks the boxes for the government and press making the lazy GPs work for their money and this will suit a person who feels that seeing a doctor on Sunday rather than being with their friends family as they cannot bear to give up a moment of work to look after their own health. We are a divided profession, this suits the government and it also suits our high-profile colleagues on their route to awards and the CMO job.

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  • Can someone remind me what happened with the funding for extended hours last year.....

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  • "many GPs abuse public money to send their own children to private school but pay their staffs peanuts"

    I can not believe I am reading this!

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  • It doesn't make sense. If the aim as stated is to reduce pressure on A&E, the target population has to be those who perceive that they have a medically urgent condition. We already have out-of-hours service for that. There is a shortage of suitably qualified doctors. If those doctors are pulled out of OOH services to offer routine appointments in their own surgeries, it seems at least possible that A&E attendances will go up.

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  • Anon. @ 1123 makes a good point. Before I (thankfully) took VER 6 months ago I regularly asked this question when working 12 hour days endlessly triaging ~ 100 phone calls per day & seeing ~ 30 patients per day in addition without a break. Pilots, bus & lorry drivers, to name a few, have statutory limits on their hours/ quantity of work on the grounds of public safety - but then again they are doing an important, valued job....

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  • I retired 3 years ago, thankfully, but I still like to keep abreast of what's going on in the world of General Practice. My, how things have changed. The only way General Practice and indeed the Health Service as a whole can survive as far I can see, is to remove control from the Government!! (Sadly unlikely to happen) Apart from providing funding they should not be allowed anywhere near the service which is merely a political football, with much of the funding wasted on ludicrous and all too frequent changes. Unnecessary administrative involvement consequently swallows up the cash which should be targeted at patient care. Don't let the b******s get you down . Best of luck!

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  • Dear Mr Kabir 10 04
    It is quite apparent that you have some type of personal agenda and axe to grind. Likley with your current employers. I think that such comments are disgraceful and not professional

    obviously,you are offended.i wonder why?mr kabir is only telling the truth.no?

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  • I don't think the policy is that all GPs have to work 8-8 7 days a week?
    Well with no money to fund any extra GPs YES we will be having to if this gets shoved down our throats like everything else. As to 'Mr Kabir' trying to say about GPs wasting money listen up! I am female and having to pay the whole mortgage, my hhusbannd earns very little, I was prevented from having kids thanks to a premature menopause striking before we could save enough to make having a kid feasible. I have no relatives working in the medical profession and never have - I was a black sheep in that respect! If I had been able to have kids although quite frankly looking at the state of this country I am beginning to feel that this was probably not a bad thing in the long run, they would have gone to normal school and not private! You are voicing stereotyped, offensive and inaccurate views and I'm sure at least 60 hours plus many hours of work at home I work as hard as you! Lucky to get anything to eat most days let alone a glass of water or a trip to the toilet!
    If you don't have an educated or relevant view keep it to yourself!

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  • And here we go again!! David Cameron falls ever deeper into "the patient trap", pandering to the every wim of the patient population. Where will this end? I dread to think. It seems as though the government and the general public wil not be satisfied until we are all chained to our desks 24 hours a day with no life outside of work whatsoever. Excuse me but we are human beings too! Also when will I get to see my bank manager/solicitor/plumber and electrician at 3 o clock in the morning ?? I await a government directive on their working hours too. Even though A&E departments are full to the rafters with patients attending inapporppriately, it does not mean that we are sitting on our behinds while these patients are A&E. We are also stretched to the limit of our capcity and in some cases way beyond. Offering these extra appointments will not solve the problem. Thes appointments will soon become saturated as well and then what will the next step be?. Instead of blaming doctors aand management and nurses and chaging their behaviour why can we not start to look at patient behaviour and abuse of the service! Patients need to dtart paying supplements for these appointments to make them appreciate the value of this precious time. Money always focuses peoples minds and thinking!!

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  • Usual anger from my colleagues - let's all quit the nhs, all it will take is one CCG, that will get the government listening. Can u imagine a government wanting re-election letting GP's go the way of the dentists?? It won't happen, we would get what we deserve. Courage of convictions is all it would take. Any CCG leaders game????

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  • I FEEL GPS SHOULD STAND TOGETHER AND NOT LET THE POLITICAL CLASS DICTATE TERMS FOR THEIR OWN MILEAGE.IF GPS HAVE TO OPEN 8-8 AND 7DAYS A WEEK WAHAT ABOUT HOSPITALS OP APPTS AND HOW CAN PATIENTS ACCESS THEM IN OOH WHY THIS RULE DOESNT NOT APPLY TO THEM.GPS ARE ALSO HUMAN AND WE HAVE FAMILY AND WE CANT JSUT BE THERE TO SERVE ONLY PEOPLE AND NOT TAKE CARE OF OUR OWN LIFE,WHY DO POLITICIANS NOT WORK 8-8 AND 7 DAYS A WEEK.

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  • Just all remember what happened last year with cutting of funding for extended hours(presumably because they think it has become part of core work!).Many of my local colleagues threw in the towel and stopped doing the extended hours ,as operating almost at a loss. Stupidly we continued and are open 7am to 8pm 3 days a week.Despite being the only ones in our area to do this we get the worst figures in the patient access survey for satisfaction with opening hours.Give the punters more and they then just expect even more. I am in my late 40s and on my knees,I see very little of my children at all as it is. I simply will NOT do this,it is purely pandering to political whims/daily mail readers. There is a huge difference between wants and needs.don't be fooled by any suggestion of extra funding-they will whip it away as soon as we have all bent over and done it as we have repeatedly done over the years-and look where it have left us,knackered,burnt out,disillusioned-need I go on. There are not enough of us to cover what we are doing now let alone 84hrs a week.

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  • Bit of a useless reply from the BMA really.
    No wonder we are getting down over so easily.
    http://bma.org.uk/news-views-analysis/news/2013/september/extended-hours-pilot-must-tackle-gp-shortage

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  • Please leave the A+E consultants out of this. I am a GP who also works in a Hospital. A+E consultants do 80 hour weekends - you remember those ? from Fri 9am to Mon 5 pm, sometimes with a total of 4-5 sleep. I know one who crashed the car going home after one ot these.
    Time for the BMA/ GPC to define safe working hours before everyone either is burnt out or left.

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  • Access 8am-8pm, including Saturday and Sunday

    Reality : extended hours funding was cut this year. There are not enough GPs to staff this and there is already an out of hours service which is stretched to the limit. .

    Flexible access including email, Skype and phone consultations for those who might prefer it to face-to-face, when it is safe to do so

    Reality: Doctors need to examine their patients.
    We already do lots of telephone consultations and triage. There are not enough resources to answer emails all day long - this would lead to complete paralysis.

    Electronic prescriptions and online booking of appointments

    Reality: Already exists in many areas though some practices computers are not powerful enough to cope with these services.

    Easier, online registration and choice of practice

    Reality: Technology already under development. Needs careful evaluation.

    Joined up services with urgent care and out-of-hours care to ensure rapid walk-in access to care

    Reality: Tried already but some Darzi centres were closed due to lack of funds.

    Greater flexibility about how people access general practice, for instance with the option to visit a number of GP surgery sites in their area

    Reality: GP shopping is known to increase clinical risk and can lead to poor care.

    Better access to ‘telecare’ to help sick people stay comfortable at home, as well as to healthy living apps

    Reality: lacks evidence base. A variety of health apps are already available but concerns have been raised about lack of quality control and regulation.

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  • If I am not mistaken the extra hours worked [contracted hours-not real hours which we know are much longer due to management] amount to 40hrs per week on top of a 52.5 hr week currently.
    Taking into account the extra management required this amounts to doubling the provision.
    This should entail doubling the budget and the rental payment.
    Not going to happen I think.

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