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Extended access pulls GPs away from surgeries, finds partnership review



Extended access services are enticing GPs away from practices, as the work is ‘easier’, the chair of the Government’s GP partnership review has said.

Independent chair Dr Nigel Watson told Pulse in some areas GPs are reducing their surgery hours to work for extended access services, due to the attractive pay and workload.

The final report from the partnership review, published today, said primary care networks – which practices will be mandated to join in return for the financial boost pledged by the Government in the NHS long-term plan – should be given the extended access funding to allow local decision-makers to manage the ‘demand appropriately’.

Speaking to Pulse, Dr Watson said: ‘In some places they have commissioned [extended access] through groups of practices working together and third party providers.

‘Largely those providers have paid GPs – to attract GPs for a three or four-hour session – a fairly significant sum per hour. There’s no paperwork largely. There are fixed numbers of appointments in a fixed timescale.’

He added: ‘What’s happening in some areas is GPs are saying that work is easier than being in the practice and pays better so I’ll cut my sessions in the practice to work over there.’

Among its 23 recommendations, the partnership review said the funding for extended access appointments should be channelled through primary care networks in the future. 

The review, published today, said: ‘Primary care networks should be enabled to determine how best to address the balance between urgent and routine appointments during extended opening hours and weekends.

‘Extended access services in many areas are attracting GPs away from practices.

‘NHS England should therefore consider how existing funding for extended access and opening could be allocated through primary care networks as they mature, to enable local decision making on managing demand appropriately.’

This could ‘reduce fragmentation of services’ and ‘improve continuity of care’, it added. 

The Government is providing funding of £6 per head for its extended access scheme in 2019-20, which Dr Watson said represented ‘significant sums of money’. 

This comes as health secretary Matt Hancock told Pulse some of the £4.5bn funding boost promised to primary care, as part of the £20.5bn NHS funding increase, will be used to relieve pressure on GPs.

Researchers previously reported patients generally value GP quality over extended access, with the attention and communication they receive from their GP being the most influential factor on their experience of general practice.

A recent investigation by Pulse found a quarter of evening and weekend appointments were being left unfilled as the policy began to be rolled out nationally across England.

Key recommendations from the report

1. There are significant opportunities that should be taken forward to reduce the personal risk and unlimited liability currently associated with GP partnerships.

2. The number of general practitioners who work in practices, and in roles that support the delivery of direct patient care, should be increased and funded.

3. The capacity and range of healthcare professionals available to support patients in the community should be increased, through services embedded in partnership with general practice.

4. Medical training should be refocused to increase the time spent in general practice, to develop a better understanding of the strengths and opportunities of primary care partnerships and how they fit into the wider health system.

5. Primary Care Networks (PCNs) should be established and should operate in a way that makes constituent practices more sustainable and enables partners to address workload and safe working capacity, while continuing to support continuity of high quality, personalised, holistic care.

6. General practice must have a strong, consistent and fully representative voice at system level.

7. There are opportunities that should be taken to enable practices to use resources more efficiently by ensuring access to both essential IT equipment and innovative digital services.

 

Source: GP Partnership Review