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The future of extended opening hours

It seems likely there will be financial incentives for practices to extend their opening hours. Lesley Mayo looks at the situation following the Darzi report

It seems likely there will be financial incentives for practices to extend their opening hours. Lesley Mayo looks at the situation following the Darzi report

There have been a number of articles on this topic over the past few months following the hints that the government is going to expect practices to be open for longer than is currently the case.

The Darzi report just published suggests that there will be financial incentives for practices to stay open longer.

Lord Darzi hopes that half of all practices will be offering extended opening hours within three years.

This is a real dilemma for GPs and practice managers who are already working in practices which are struggling to meet increasing demand and for staff who are constantly under pressure. Although the reality may be a little way off, it seems prudent to start planning now rather than wait for the inevitable. There are many different types of practice and there will not be one solution that suits everyone. It will be for individual GPs and their managers to find the best model for them.

In my own practice we already offer appointments from 8.00 a.m. to 6.50 p.m. so I decided to start by asking the partners what their views were on extended hours. I asked them to complete a short questionnaire. The results showed that all were willing to do early surgeries with a 7.30 a.m. start. None were keen to do surgeries that went on until 8.00 p.m. nor did they want to restart Saturday morning opening. Unsurprisingly none of them wanted to do extra sessions, so we would be offering the same number of appointments over a longer time period. They also agreed that other staff such as nurses and salaried GPs should be involved in offering extended hours.

Initially we are aiming to offer early starts and late finishes on 3 days each week. The situation with regard to out of hours cover is currently so unclear that the partners have agreed that telephone lines will be closed from 6.30 p.m. and all the appointments will be booked in advance.

The next step is to make staff aware of the plan to offer extended opening hours. We have a team of receptionists, both full and part-time. They all work a seven hour shift and all of them work both early and late shifts. There is an overlap in the middle of the day which allows for lunch breaks and also gives the staff a chance to carry out the many other tasks they are required to do. A presentation to all staff is a good start. Make clear the challenges ahead for your practice and emphasise the fact that future funding may depend on access to the practice. Ask staff to think about possible solutions to the problem.

One of the main difficulties that we face, which I suspect will be true of most practices, is that it is impossible to offer extended hours with the same number of staff. We have a duty of care to our staff and for safety reasons we must have two receptionists on duty at all times. I have calculated that we will need at least one additional receptionist for 28 hours each week. Allowing for on costs, this represents a cost to the practice of around £14,000. The likely reality is that practices will be faced with staff who are reluctant to change their hours or may be unable to do so. This is the time to consider whether to use the carrot or stick approach. Staff contracts should contain a clause which allows changes in shift times. Even so I would still advise open discussion with staff before changing shift times as an employee could potentially raise a grievance against the practice.

If staff contracts do not allow for changes to shift times, these will have to be redrawn to make provision for new shift times. Such changes will need to be negotiated carefully with staff. Consider incentives for unpopular shifts such as offering a higher hourly rate for hours worked after a certain time. I personally am against this as I feel it leads to division amongst staff but it may the right option in some practices. It is possible that some staff will prefer to reduce hours and this may give the flexibility to employ an additional staff member.

If after negotiation there is no agreement, there are a number of possible ways to proceed. Practice could impose the change without the consent of the employee. This is a breach of the employee's contract of employment and should be avoided. However if an employee works new hours without protest, after a reasonable period (likely to be a few months) he or she will be deemed to have accepted the change. If an employee works the new hours but continues to protest there would be no deemed acceptance and the practice would remain in breach of contract, running the risk that the employee could resign and claim constructive dismissal.

The final option open to practices would be to terminate the contract of employment and offer to re-employ him or her on the new terms. The correct notice must be given and the correct dismissal procedure followed. To be fair there must be a valid reason for dismissal. In this situation the dismissal would be classed as dismissal "for some other substantial business reason".

A word of caution; staff are the single most important asset of any practice, and one would obviously hope to come to a mutually satisfactory compromise. We all rely on our dedicated staff and it is clearly unwise to alienate them at a time when practices are increasingly under threat.

Extended opening hours present a major challenge for General Practitioners and their staff. I have mentioned the possible staff costs which practices might face – and one really does hope for good financial incentives as a result of the Darzi review - but there are other issues to consider such as health and safety, utilities, insurance which must all be factored in to the calculation.

Our practice is planning to offer extended opening hours but, like everyone, we are reluctant to offer extended hours without seeing the funding up front.

My advice is to start making plans but consider carefully the costs involved and wait until the guidance is clearer.

Lesley Mayo is a practice manager in north London

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