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GPs face pay cut as patients shun extended hours

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.

A Pulse investigation reveals PCTs across England are writing ‘utilisation' clauses into extended hours LESs, to withhold payments from practices if they fail to fill surgeries above a certain threshold.

The controversial move has been opposed by LMCs and described as ‘wholly inappropriate' by the GPC, which said it was unacceptable for trusts to be offering LESs at worse terms than the national DES – which does not have any utilisation requirements.

At least three trusts have so far rewritten LES agreements to require practices to meet certain utilisation targets, while a series of others have ramped up their scrutiny of GP performance.

NHS Berkshire cluster, which covers Berkshire East and Berkshire West PCTs, has rewritten its 2012/13 LES to include a 70% utilisation target, which practices must achieve to receive full payment, after identifying a number of practices running largely empty extended-hours surgeries. The PCT said in 2011/12 two practices had a utilisation rate of between 50% and 70%, one between 30% and 50%, and three practices 30% or lower.

A spokesperson said: ‘While the majority of practices across Berkshire are reaching the 70% target, both PCTs are closely monitoring uptake over the coming year. We'll provide assistance to practices not reaching the target before considering reclaiming funding.'

NHS Trafford inserted a clause into its 2011/12 LES agreement last June demanding practices achieve 75% utilisation to get paid, while other LMCs in the North West have resisted an SHA-led attempt to set a 75% threshold.

Peter Higgins, chief executive of Lancashire and Cumbria consortium of LMCs, said: ‘They attempted to talk to us about it but we wouldn't go there.'

Other trusts are increasingly scrutinising utilisation rates amid mounting evidence that extended-hours surgeries, first rolled out under the Labour government in 2008, are not being heavily used by patients.

NHS Sheffield has collected regular audit data from 68 practices signed up to its LES, and reported that two practices had utilisation rates of just 50%. NHS Bristol said it aspired to 80% utilisation, and practices failing to achieve this over a three-month period would be required to establish an action plan, while NHS North Lincolnshire said one practice had stopped providing extended hours after a PCT review of utilisation.

NHS North Somerset said it had analysed extended hours take-up during 2010/11, and found utilisation improved at some practices when opening times were rescheduled. It added: ‘It was not always workers or commuters who wanted early morning or late afternoon slots. Elderly and retired [patients] used the early slots too as they could get relatives to transport them before work.'

GPC negotiator Dr Chaand Nagpaul said: ‘It would be wholly inappropriate to put a requirement in a LES that was less favourable than the DES. No practice should have to provide data or be scrutinised in a way that goes beyond the core DES.'

Dr Paul Roblin, chief executive of Berks, Bucks and Oxon LMCs, said: ‘If practices have done all they should to advertise the availability of extended hours and it's all due to low patient demand, I don't think any clawbacks should occur.'

Falls in extended hours funding

2008: £158m recycled from Access and Choice and Booking DESs to create Extended Hours Access DES

2011: DES payments cut from £3.01 to £1.90 per patient – but some flexibilities added

2012: PCTs insert clauses in LESs to allow them to reclaim funding for unfilled appointments