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Your questions on the extended hours DES answered

Andrew Lockhart-Mirams of solicitors Lockharts answers your questions on the extended hours DES, which will come into being after GPs accepted Option A' in the contract poll. He also covers legal issues surrounding the imposition of the deal and what it means for the future of the GP contract.

Andrew Lockhart-Mirams of solicitors Lockharts answers your questions on the extended hours DES, which will come into being after GPs accepted Option A' in the contract poll. He also covers legal issues surrounding the imposition of the deal and what it means for the future of the GP contract.

Q: Hypothetically if during the extended hours opening for registered patients by appointment but outside of the "Core medical Services Hours", would I be required to offer "immediate and Necessary treatment" requiring a face to face assessment as in Core hours or could I use a protocol to instruct staff to direct to the out of hours primary care service or walk in centre?

I suspect the GMC would feel my professional duty of care may not be regulated by the contract; I require the contractual obligation.

A: The present understanding is that the extended opening time would be used for routine booked appointments in accordance with normal working practice and this would suggest that, ‘Immediately necessary treatment' would have to be provided. No doubt, however, the position will be clarified when the extended opening DES is published.

Q: The stated basis of the extended opening is to allow time for people who do not wish to take time off work to consult for their health needs. Is it possible to specify criteria to ensure only patients who are employed book the additional slots or would this be an illegal discriminatory measure; obviously if people not employed use the enhanced opening slots this would delay appointment provision for the employed.

A: Whilst it is anticipated that extended opening will be to facilitate better access for people who do not wish/are not able to take time off work to consult about their health needs, the present indication is that the time would be for routine booked appointments in accordance with normal working practice and thus it would seem that no particular preference should be given to such people.

Q: What sort of appointments will we be able to offer in extended hours? If we take telephone calls on the day will we be, as has been suggested, subject to the rules of OOH providers (response times etc)?

Should we (and indeed can we) turn them away at the door and send them to the PCT OOH provider? Should we not answer the 'phone?

A: The present understanding is that the provision of out of hours care would remain the responsibility of PCOs and thus it would appear that rules appropriate to OOH providers, such as response times, will not apply. The general understanding is that extended hours will be for routine booked appointments and that the core hours for services provided will remain unchanged.

Q: How can the government unilaterally change the contract in this way? What's to stop them doing it again? Why isn't the BMA mounting a legal challenge?

A: It always has to be remembered that Parliament is sovereign and that the Government, on a domestic issue such as this, can enact such legislation as it wishes. I do not know the extent to which the BMA has considered mounting a legal challenge but certainly the principle set out above would probably make such a challenge very difficult to sustain.

Q: Are these extended hours additional or replacement? I.e. Can we shut up shop during the day to compensate for the extra time/cost of opening in the evening?

A: The present understanding is that the DES will provide for extended hours and that core hours for services provided will remain unchanged. Accordingly, it would appear that unless the PCT is agreeable, the present arrangements during core hours will need to continue in place.

Q: If the PCTs make enquiries about our current level of service to establish a baseline so they can subsequently see if any practices are playing silly buggers by withdrawing daytime services to compensate for evening opening are we legally obliged to answer?

A: The Department of Health's circular letter to SHA Chief Executives (Gateway reference 9410) of 30 January 2008 makes it clear that PCTs are asked to carry out a baseline audit of current availability of GP appointments to ensure that extended hours are genuinely additional. Annex B to the Department's letter contains a suggested template for baseline audits. The obligation for GMS practitioners to provide relevant information is contained in paragraph 77 of Schedule 6 to the GMS Regulations.

Q: If two partners, say, do an hour each in the evening, does that count as one hour of extended time or two?

A: The present understanding is that other than exceptional circumstances (such as large practices) and with PCO agreement, the additional time will have to be delivered by one GP only working at a time.

Q: Will we be able to shut the phone lines during our extended hours? If not, what's to stop us having some OOH work dumped on us by default? Similarly, if someone just turns up on spec as an emergency in the evening, can we insist they contact the OOH service as we're running 'appointments only'?

A: The present understanding is that you will not be able to shut your telephone lines during extended hours as the time provided has to be operated in accordance with normal working practice. Out of hours care, however, will remain the responsibility of the PCO.

Q: Since surgery extended hours will overlap with the service offered by local out of hours providers; Could the PCT seek to reduce its financial obligations to OOH suppliers? If they did, would OOH suppliers be able to seek recompense for unilateral changes in contract etc?

A: It is likely that where extended hours are provided, there will be some reduction in the need for OOH services during the extended hours period. No information, however, appears available at present as to how PCOs may seek to renegotiate OOH provision with providers.

Q: If our part-time reception staff work extra hours to cover extended opening, should we change their contracts to reflect the extra hours or pay them overtime? Should this be at their basic hourly rate or extra to reflect they are unsocial hours?

A: Staff contracts will need to be amended, with the agreement of the staff member, in order to reflect extra hours of work and this may involve paying overtime.

Andrew Lockhart-Mirams

The present understanding is that you will not be able to shut your telephone lines during extended hours as the time provided has to be operated in accordance with normal working practice.

Staff contracts will need to be amended, with the agreement of the staff member, in order to reflect extra hours of work and this may involve paying overtime.

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