Exclusive More than half of England’s CCGs are already considering plans for extended opening in GP practices above and beyond the current incentivised service, with more than a quarter at the stage of actively planning such schemes, Pulse can reveal.
Figures obtained from 129 CCGs under the Freedom of Information Act reveal that 57% of CCGs are either actively planning commissioning of extended hours – above and beyond NHS England’s extended hours DES and the central pilot scheme announced by the Prime Minister – or are considering doing so.
The schemes being actively planned are a variety of extended services funded by CCG money and, in some cases, approved bids from the central ‘winter monies’ pot, the £500m the Government is giving to certain areas to deal with urgent care pressures this winter.
As previously reported by Pulse, practices around Greater Manchester will be taking part in a £2m scheme to improve services to patients, including access, while three practices in Westminster in central London will open a weekend walk-in service to registered and non-registered patients.
But this investigation reveals the extent to which CCGs are planning to commission such schemes across the country, with a quarter of CCGs citing a reduction in A&E pressures as their main reason for pushing ahead with extended hours.
A total of 129 CCGs responded to Pulse’s request. Of these, 57% said they were planning or considering extended hours schemes, with only 9% saying they were not planning any such scheme. The remaining 34% said they did not hold any information. Of the 129, 26% were actively planning these schemes, with 31% considering plans at this stage.
NHS Wiltshire CCG has said it will extend GP hours using a £450,000 pot of money part-funded by the CCG and part-funded with winter monies while NHS Lewisham CCG will pay GPs £100/hour to extend opening as part of a local urgent care incentive scheme aimed at reducing winter pressures. NHS Ealing CCG has said it will invest £90,000 towards GP morning walk-in sessions and £300,000 towards a morning ‘duty doctor’ scheme, also funded with winter monies.
Other CCGs considering commissioning extended hours include Oxfordshire, Islington, Waltham Forest, Camden, North Durham, Brighton & Hove and Nottingham West.
The news comes after the Government announced a £50m ‘pioneer’ scheme across England, which GPs will be able to bid for from December in return for providing improved access in weekends and evenings as well as via new technology.
GPC deputy chair Dr Richard Vautrey said he was ‘not surprised’ at the number of CCGs formulating plans to extend hours, especially in light of the recent political focus on this area. He warned that the real test would be whether the Government would commit to fund extended hours in the longer term.
He said: ‘PCTs previously have commissioned extended GP opening in various ways so these figures do not surprise me in light of the recent focus on this area. The important issue is that practices need to be able to plan for the long term and take on additional staff. Otherwise the risk is that even with additional short-term resources, all that happens is that the current workforce is either spread more thinly and therefore the quality of the current in-hours service is put at risk, or clinicians are encouraged to work longer hours with the risk they become more tired and make mistakes. In addition there is little point practices opening longer if the necessary support services are not available as well.’
Dr Vautrey added: ‘Clinicians in practices and out-of-hours organisations are working harder than ever before. What is really needed in a long-term commitment to increase the funding general practice receives so that this increased workload can be dealt with by expanding the general practice workforce.’
Dr Charles Alessi, chair of the National Association of Primary Care, welcomed the CCGs’ plans. He said: ‘Extending the hours of availability for general practice is a good thing and should not be looked upon negatively as long as it is the start of a “whole system” redesign and as long as this does not mean GPs working even longer hours than they work now.’
‘There are plenty of schemes which improve access for patients and this is one of them. It is perfectly reasonable that the people who work extended hours should be adequately remunerated.’
Dr Ivan Benett, clinical director at NHS Central Manchester CCG, which is receiving £500k of the £2m funding for CCGs in Manchester, said: ‘Our overriding ambition is to provide a service for the people of central Manchester that is consistent and of the highest quality. We have pockets of excellence but also great variation in activity and outcomes. The first step is to be available when people are ill, or believe themselves to be ill. This means increasing the capacity in primary care to see more people at the times they are able to access the service.’
‘Our aim is to begin to offer longer opening times by this Christmas to the population of one of our localities. Primary care will be open for business 8am to 8pm weekdays and for three hours on Saturdays and Sundays. When surgeries are closed people will be seen at a locality hub. We want people to come to this service rather than go unnecessarily to A&E, especially between 6pm and 8pm.’
Examples of extended hours schemes:
NHS Ealing CCG – will run two schemes to approve the availability of GP appointments funded by ‘winter monies’. Monday to Saturday it will run a GP walk-in service that will see practices opening for morning sessions which patients can access without an appointment six days a week – this scheme has been allocated a £90,000 budget. A second scheme, worth £299,520, will see GP surgeries offering a ‘duty doctor’ service two days a week (proposed to be the two days a week when practices experience the highest demand for appointments).
NHS Central Manchester CCG – A small number of practices will open for additional hours until 8pm Monday to Friday and for six hours over the weekend (expected to be three hours on Saturday and three hours on Sunday). Part of the Greater Manchester ‘demonstrator project’ in which central Manchester is one of six areas participating, There is no defined staffing requirement, other than ensuring GP availability. The CCG has been allocated £500,000 for the project as a whole, with a large proportion being put towards extending access.
NHS Central London CCG – will be paying GPs £94/hour to run a walk-in service at weekends open to both registered and non-registered patients. CCG leaders say that the scheme, which has a £250,000 budget, is intended as a ‘viable alternative’ to attending A&E for patients in Westminster. Practices are required to provide one GP, one nurse and one admin staff member during these sessions, with nurses paid £35/hour and admin staff £15/hour. The CCG says: ‘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 8.43% reduction of unregistered patients being redirected to this service.’
NHS North Durham CCG – has a scheme in place to increase access for patients to GP practices during weekends between 1 October 2013 and 31st March 2014.
NHS Lewisham CCG – Practices paid £100/hour for providing extra hours. It has to provide a GP and other practice staff to support the additional clinics/appointments e.g. reception staff.
NHS Waltham Forest CCG – commissioning the development of GP provider networks which it sees as a delivery model to transforming services and improving access.
Source: Pulse FOI request to CCGs in England