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Gold, incentives and meh

Longer GP opening hours needed to boost productivity, says Monitor

GP should open longer and expand their surgeries to take on an additional 16m appointments from hospitals and plug a £30bn NHS funding gap, Monitor has said.

The health regulator said that GPs should be asked to increase their productivity by 10% to 20%, enabling them to see an extra two to four patients a day.

In a report out today, it said that by revising the appointment system, changing job roles and using telephone triage and telephone appointments GPs could free up time to do this.

The report comes after the Government announced pilots of extended access in the evening and at weekends with the aspiration of extending GP hours nationally.

The report, titled Closing the Gap, also said consolidating GP practices to reduce running costs and make better use of estates could save the NHS between £200m and £300m annually.

Monitor predicted that the NHS will face a £30bn funding gap by 2021 and listed a range of saving and productivity measures that could make up the difference in the report. Overall, Monitor suggested primary care could save between £1.2bn and £2.5bn annually just by improving productivity.

The document said: ‘Increasing the size of GP practices, reducing running costs and making more use of the estate, for example, by having longer opening hours, could improve asset utilisation for GPs’ practices. Consolidating practices will not always be feasible or even desirable in some areas. But new forms of collaboration between practices could deliver similar advantages. For example, smaller practices could collaborate to form networks serving 50,000 to 70,000 people. This would maximise the use of skills, co-ordinate care better and increase capacity.’

It adds: ‘Operational improvements in general practice could be achieved through a combination of revising appointment processes, changing job roles within primary care and using telephone triage and telephone appointments. Taking such measures could enable a typical practice with an average list size of 6,500 to add an extra 50 to 95 appointments a month. Measures to rework appointment and diagnostic processes could also free up GPs’ time, allowing them to focus on more complex patients and help meet future demand. The gains for patients from these measures could be considerable.’

However, Monitor also suggested GPs practices could take on an extra 10-16 million patients currently treated as hospital outpatients.

The report said: ‘Shifting outpatient activities to primary care settings, where they could be delivered by GPs with a special interest could realise gains of £0.7 billion. An estimated 10 million to 16 million outpatient attendances in hospitals could take place in primary care.’

David Bennett, chief executive and chair of Monitor, commented: ‘Over the next eight years, the health sector faces its greatest financial challenge in recent times. We are all going to have to strain every sinew to meet it. While there are individual things the sector can do - like be more efficient in its procurement or introducing new ways of working in hospitals - what is required is a step-change. In short, the NHS must undergo radical change if it is to survive. Monitor, as the health sector regulator, will not only be supporting, but actively enabling changes that deliver better services for patients and reduce costs.’

Readers' comments (29)

  • Yawn............ maybe cutting funding for monitor would be a step to saving some cash.......

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  • If you really want to increase productivity remove home visits completely, a gp could see 6 patients in the time it takes to do 1 home visit and achieve better outcomes.

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  • why dont we do just EVERYTHING in primary care!...
    Gp practices are at bursting point already. there is no funding. yet they want us to take on OOH, provide 24/7 care for the patients, open 7 days a week, provide extended hours opening, triage all the appointments, manage hospital out-patient ...
    Clearly, these people have got nothing better to do than to come up with such absurd and unworkable suggestions. We dont even have a big enough workforce in the first place!. I agree with the first comment, get rid of costly organisations like Monitor and invest in primary care.

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  • yeah , why not join up with that phone company EE , everthing every where , certainly good marketing opportunity as I sit here during an extrended hours session when thankfully half the patients sensibly remained in bed and didnt show up!

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  • Doing everything in Primary Care is obviously the way to go. I am happy to lead this exciting initiative and have asked my good friend Jeremy to send the NHS Budget to my address in the Cayman Islands.

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  • And what the hell did 'Monitor 'have to say about increasing out put and productivity in secondary care !!!!!!!
    Whats more - any overpriced comment form them about the controllers ( cameron + hunt) reporting the positive effects of a pilot scheme soon to be rolled out which actually has not seen any patients !!
    I despair.........

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  • I have two words to say to monitor and neither of them are nice

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  • Ashley Liston

    Reading this article it was so predictable that it would be met with a stream of angry, nihilistic comments from GPs only seeing more work coming their way.
    Is it possible that with a little imagination we could work smarter? Our practice has adopted the rapid response telephone consulting model with all requests for appointments resulting in a telephone consultation which in over 60% of cases resolves the problem to the satisfaction and convenience of the patient. I can now spend far more time in face to face consultations for those who need to see me. Patients also are booked with nurse practitioners or registrar or their own doctor depending on the problem, it's urgency and whether it needs continuity of care.
    Result--very happy patients, staff and doctors. Efficient use of NHS resources and massively reduced A+E and unplanned admissions.
    We need to adapt to changing times. Our patients deserve it and the NHS needs it.

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  • There is a strange agenda going on with telephone access. The last comment suggests 60% can be dealt with over the phone. That leaves 40% that need face to face assessment following telephone triage and therefore duplicates work. I cannot see how there are any 'net' savings in practice time from this approach. This would only be of interest if there is an effective way to get the right patients to the right appointment rather than duplicating work.

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  • Monitor are probably correct in what they are saying but we do not have the resources to fulfil their ideas. Next year a load of money will be removed from QoF and given to access, announced as 'funding' we'll be vilified for taking more money to provide what the 'modern' world need 24/7/365. Most of us will [Baa!!!] comply as we have mortgages and bills to pay like the rest of the country. Until we negotiate a contract that isn't open ended and unilaterally able to be altered we need to lube up, shut up and get on with whatever is thrust at us. We are useless at negotiating with the government when we are essentially contractors. Now is the time to say what we will provide and for what remuneration or withdraw from negotiations and close our surgeries. Mortgage be damned-rock/hard place.

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