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GPs stick with extended hours despite funding cut

By Gareth Iacobucci

Exclusive: The majority of GPs are set to continue providing extended opening hours this year despite funding being cut by more than a third, Pulse can reveal.

Our snapshot survey of 33 primary care organisations has found that practices are signing up to the new terms negotiated by the GPC – which reduced DES payments from £3.01 to £1.90 per registered patient – but many have negotiated additional flexibilities with managers in order to make the move financially viable.

Our investigation found that 76% of practices have accepted the terms of the national extended hours DES or a local LES and will provide extended hours this year, falling only slightly from 78% in 2010/11.

But many of those operating under the new terms have been forced to introduce new measures – including concurrent working and allowing other healthcare professionals to staff extended hours appointments – to ensure they can offer the service. In the 17 PCOs that were able to provide comparative figures on extended hours, 828 practices opted in, compared to 803 last year.

But the picture surrounding uptake of the new patient participation DES is still unclear, with many trusts setting a deadline of the end of May for practices to decide.

Our survey also found that nearly three-quarters of trusts have begun discussions with GPs about reducing referrals and improving prescribing efficiencies to meet new QOF indicators.

There appears to be a divergence in negotiating approaches on the indicators however, with some PCOs in discussion with LMCs and individual practices, and others choosing to open talks with new GP consortia.

The findings follow GPC chair Dr Laurence Buckman's prediction that the majority of practices would retain extended hours because of the increased flexibilities secured in this year's deal, which also allows appointments to be made for urgent as well as routine care and lets GPs reduce the minimum period of extended hours sessions from 90 to 30 minutes.

Dr Chaand Nagpaul, GPC negotiator with responsibility for enhanced services, attributed the support for extended hours to the 'opportunities for cost efficiencies' presented by the increased flexibilities, such as using nurses to work alongside GPs and reductions in expenses by having shorter appointment slots. 'To some degree this mitigates the decreased value of the DES,' he said.

But Dr Philip Fielding, a GP in Cheltenham who provides extended hours at his practice, warned resources were stretched under the terms of the new deal.

'When you add in things like security, opening the reception and opening the building, you realise how little pay it is for providing that service,' he said.

'There is great concern that they have valued extended hours so poorly that this will have an effect on delivery of services. We are restricting what we can do – for example, blood testing and referral activity.'

Dr Ulrich Pfeiffer, a GP in Liverpool, said the new terms made extended hours even less attractive: 'It was never worthwhile doing it in the first place.'

Dr Philip Fielding New flexibilities for extended hours

• Appointments can be offered by any healthcare professional rather than GPs only
• Previous restrictions on concurrent working removed
• Patients can be seen for urgent as well as routine care
• Minimum continuous period of extended opening reduced from 90 minutes to 30 minutes

Source: DH, extended hours DES – 1 April 2011 to 31 March 2012

Practice Business

Read Dr Helen Clark's advice on surviving the extended hours funding squeeze