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Can the Prime Minister really get GPs to open all hours?

As David Cameron plays politics with practice opening hours, Sofia Lind looks at whether his scheme will get off the ground

Once again, GPs have found themselves caught in the political crossfire. Searching for a new policy to reveal at the Conservative party conference last month, the Prime Minister settled on GP practices opening until 8pm on weekdays and also holding weekend surgeries.

Health secretary Jeremy Hunt quickly issued a press release hailing a ‘successful’ seven-day opening scheme in Manchester as a blueprint – but then the Government’s high-profile claims began to unravel. After a series of questions from Pulse, the Department of Health was forced to admit the Manchester scheme has yet to get off the ground.

The DH says a ‘pioneer’ scheme in nine areas will trial extended and weekend opening in 2014/15 with additional funding of £50m, but remains tight-lipped on whether the NHS can afford the £2bn some estimate the scheme will cost to roll out nationally.

On closer reading, the DH press release referred to ‘groups of practices’ working together to deliver seven-day access for patients – but the wall-to-wall media coverage that followed left the impression that every practice would be required to open on Saturdays and Sundays.

Former GP Dr Sarah Wollaston, now Conservative MP for Totnes in Devon, told Pulse the Government would be ‘over-promising’ if it suggested GPs across the country could stay open every day of the week for routine appointments.

Scant support from GPs

There is also considerable opposition to the idea among GPs, many of whom remember the empty surgeries generated by the previous Government’s extended hours experiment.

A Pulse survey of 525 GPs shows the profession is overwhelmingly opposed to Mr Cameron’s plans, with 85% saying the £50m seven-day working pilot is not a good use of NHS resources and just 9% supporting it.

Survey respondents estimated that providing extended hours at evenings and weekends would cost their practice an average of £6,500 per week, or £338,000 a year.

Based on 8,000 GP practices, this would equate to an additional investment in general practice of around £2.7bn  – something the NHS can ill afford.

The health secretary told the RCGP conference in Harrogate last month that he planned to fund his primary care reforms by cutting the QOF and making savings in other areas that would ‘flow back to practices’.

Mr Hunt said:  ‘The only way we are really going to solve this is if you save money by more proactive care, some of the savings you make for the NHS will flow back to your practices.’

But GP leaders are clear the plans will require significant additional investment. Dr James Kingsland, president of the National Association of Primary Care and a former Government adviser on commissioning, believes the plans will require an additional £40 per patient.

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

From the pilot he estimates that an extra £15 is needed to offer patients extended hours during the week, £20 for the weekends and £5 to cover recruitment and administrative costs.

Dr Kingsland told Pulse: ‘A total of £40 per head of population would deliver 12-hours-a-day, seven-days-a week access to routine and urgent care.’

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

CCGs move to extend access

David Cameron’s extended opening drive does not exist in a vacuum of course. Currently more than 60% of practices provide extended hours under the DES in England.

But CCGs are planning to do more locally. Figures obtained by Pulse from 129 CCGs under the Freedom of Information Act reveal that a quarter are already actively planning locally extended GP hours in a bid to take the pressure off secondary care services.

More than half (57%) said they were considering, or would consider, extending GP access to address the crisis in A&E departments; close to half of these were already at the active planning stage of rolling this out alongside local area teams.

Only 9% (11 CCGs) said they were definitely not considering this, while just over one-third (44 CCGs) said they held no information on schemes for extended GP hours.

NHS Central London CCG, which commissions services across the borough of Westminster in the centre of the capital, said it would be paying GPs an hourly fee of £94 to run a walk-in service at weekends for patients, regardless of whether they are registered with that practice or not.

CCG leaders say that is intended to be a ‘viable alternative’ to patients attending A&E. Practices will be required to provide one GP, one nurse and one admin staff member during these sessions, with nurses paid £35 an hour and admin staff £15. The scheme has a total budget of £250,000.

A CCG spokesperson said: ‘The programme is based on the success of a similar pilot using winter funding, which estimated a 31% reduction in A&E attendances and an 8% reduction in unregistered patients being redirected to this service.’

Other areas considering offering funding for extended hours include NHS Lewisham and  NHS Ealing CCGs in London, and NHS Wirral CCG in the north-west.

GP access graphic Nov 2013

Resources

Mr Cameron can take heart that he is supported in his mission to extend GP access by the new CQC’s chief inspector of general practice, Professor Steve Field, who said that he would look for signs of ‘poor access’ as part of a new inspection regime coming into force next year.

The GPC has not dismissed the idea of seven-day working, with chair Dr Chaand Nagpaul saying he will ‘work with the Government’ to improve access, but it is demanding additional resources to deliver the plans.

Dr Nagpaul says: ‘Without extra GPs, the existing workforce will have to be stretched over seven days, meaning potentially reduced services during the week. It will also require additional resources and investment in support and diagnostic staff, such as district nurses, and access to community care so GPs can meaningfully provide a full service across the week.

‘It remains to be seen if the money set aside will be enough to deliver this.’

The Prime Minister has staked his own reputation on this high-profile initiative. But there is clearly a long way to go before his plans can be seen as credible. As things stand, there is little evidence that GPs have the will, or that the NHS has the resources, to deliver them.

What happens next?

From December, GPs will be able to apply to their local area team to take part in the Government’s £50m pioneer scheme for extended access.

The process will be run as a competition, with the most innovative applicants awarded funding to trial seven-day working from April next year.

GPs will not just be expected to open from 8am to 8pm on weekdays and to offer access on Saturdays and Sundays. The DH has said they will have to demonstrate that they will test a variety of ‘forward-thinking services to suit modern lifestyles, including greater use of Skype, email and phone consultations for those who would find it easier’.

Readers' comments (17)

  • Yes he can.
    The contract can be changed with 12 weeks notice
    Next question?

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  • If the contract is changed with 12 weeks notice then that will mean practices will do it for three months only. Most practice agreements require 6 months notice.

    I predict the day the contract change is announced will be the day many of us hand in our resignations.

    David Cameron will preside over the biggest manpower crisis General Practice has ever seen.

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  • T Roscoe

    extending the hours requires more GP time to be available. If everyone did it then it would require a third more GPs. Otherwise the appointments in the week would have to reduce by a third. No matter how much money is made available, it just is not possible.

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  • my biggest issue is who are these appointments at weekends aimed at: those who have a genuine medical need or those who shout the loudest? If you wish to offer non urgent appointments then it needs to be done by your normal routine GP, and they will need to reduce their in hours working schedule to accommodate this, so in total no additional GP hours. If it is aimed at urgent cases then it can be shared amongst a group of practices, but how does this differ from the old style co-ops? and if doing a mixture then im not sure how this will work. We do not have enough OOH work to justify opening , can go for 3-4 days without an OOH contact.
    A huge amount of the GP workforce already work time, whether for family committments or as portfolio GPs so they do not want to extend their working week. If they were prepared to work those additional hours they would be full time GPs already. So it will end up as salaried or locum Drs doing the work so again no continuity of care. The only people this serve is middle aged full time workers who make up about 5% of our workload, most of which is urgent care.but they happen to shout a lot and have power at the ballot box

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  • We already have a looming recruitment crisis in general practice. Seven day opening for routine care can only make it worse.

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  • Report and comments are sane and thoughtful. It is not in sync with the dishonesty of government nor with the fictional 'need' to cut costs.
    You are right to say added facilities involve greater costs. Staff have been refused 1% income increase; there's no hope of a reasonable solution. It's a game of 'blame GPs' which no one wins!

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  • There is one overworked and highly stressed workforce and you cannot ask it to do more at weekends without it doing less during the week. That is obvious to any intelligent person.To pretend otherwise is nonsense, and simply political spin. Are you guys really in touch with the real world or are you all in cloud cuckoo land. Jeremy I am really worried about you. You should have a chat with your G.P.

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  • Knowing well that they are well behind in opinion polls the desperation of the Government is shown by the daily rubbish filled statements issued by them and trying to play with public sentiment. They will require loads of GP and sackful of money to put their ideas in place.Who knows tomorrow they will ask contractors to build high speed rail for free like they are asking GP to work for free for them.

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  • Exclusive: GPs who fail to fill extended-hours surgeries are to have their pay docked by NHS managers, after a series of PCT audits found many patients are shunning evening and weekend appointments. This is from a Pulse article May 2012. Didn't work last time, will it this time? ....no

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  • Peter Swinyard

    One thing not yet commented on in this good debate on excellent article from Sofia is this:

    "The health secretary told the RCGP conference in Harrogate last month that he planned to fund his primary care reforms by cutting the QOF and making savings in other areas that would ‘flow back to practices’."

    This is DoH code for "You don't llike this year's imposed QOF changes. You would like the QOF burden to reduce. We will reduce your grievous burden. We will obviously then remove the resources which were attached to such nonsense as the GPPAQ. You can then earn back these resources by working 7 day weeks". Watch out, GPC.

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