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UK disparities widen on extended hours DES

By Gareth Iacobucci

Divisions between the different UK countries over implementation of the extended hours DES have widened after Scottish GPs were handed extra cash to pay for practice nurse support.

The Department of Health ruled out any equivalent funding south of the border, but it did leave the door open for PCTs to offer local deals.

Scottish GPs are already allowed greater flexibility than in England over the blocks of time they can offer extra hours in, and are now to receive an extra £2.65m to ensure nurses can work alongside them when practices open longer.

But the award is controversial because it is to be funded out of the extra 1.5% investment in general practice promised as part of this year's contract negotiations, and intended for a mixture of clinical and access initiatives.

It comes despite the continuing standoff between ministers and the GPC over the legality of this year's pay deal.

Scotland's minister for public health, Shona Robison, said: ‘We know GPs don't work in isolation and nurses are a critical part of the care practices provide. This extra £2.65m funding will further enhance extended hours by investing in vital nursing support during those hours.'

But a BMA Scotland spokesperson told Pulse: ‘We're not sure why this has been announced when the pay deal's still being contested, but they have gone ahead and done it without any agreement from us.'

Dr Dean Marshall, chair of the Scottish GPC, said he was worried at the use of the 1.5% funding to further push extended hours: ‘Scotland's GPs believe it is inappropriate to direct further NHS funding towards extended hours in preference to more pressing health needs. Many of our staff work in general practice because the hours fit with their family commitments and it is unlikely that practice nurses will be more inclined to work evenings and weekends under this scheme.'

But GPs in England said the money might prove essential to the delivery of extended hours, after some LMCs calculated GPs would need to receive 60% more per patient than offered just to break even.

Dr David Shubhaker, a GP in Waltham Forest, east London, whose practice already offers extended hours, said the cross-border disparity was ‘of great concern'. He said: ‘In Scotland, the funding is very sensible. You cannot give a service without a proper starting structure. To be truthful, Scotland has been more sensible in many issues, including prescription charges.

‘Having just a GP and a receptionist is not safe, and if there is a need for a wound or dressing or any emergency, you don't have a nurse to assist you and it becomes a total waste of time to give appointments and not back up the proper services.'

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