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Seven day 8am to 8pm GP access policy ‘under review’

Exclusive Seven-day access will be reviewed to make sure it is ‘sensible’ for practices, as part of the move to primary care networks, NHS England has said.

Speaking to Pulse, NHS England primary care acting director Dr Nikita Kanani said that the current extended access schemes and funding pots need to be combined to form one service and one funding stream for practices.

She added that the requirement for patients to be offered seven-day 8am to 8pm access was under review.

GPs have called for the review to take workforce into consideration when deciding what practices should offer, and warned against imposing a strict scheme like seven-day access onto practices, instead calling for a scheme that provides what is needed and what will be used, rather than ‘access for the sake of access’.

This comes as NHS England and the BMA announced the new five-year GP contract, which said that from July, the extended hours access DES requirements will be transferred from practices to networks, to enable them to ‘deliver at the right scale’.

The change means NHS England will no longer directly pay practices to deliver the service, with the funding going to networks to distribute instead.

Under existing extended hours DES, practices are paid to ‘offer patient consultations face to face, by telephone or by other means at times other than during the core hours’.

But NHS England said it intends to move the service’s funding to networks, coupled with ‘the wider CCG commissioned extended access service, to fund a single, combined access offer’.

Addressing whether GPs will still be expected to provide seven-day 8am to 8pm access, Dr Kanani said: ‘We’re going to review the access requirements for networks, so we will start that from this year essentially. Just to make sure it’s sensible.’

Dr Kanani told Pulse she hopes to bring all the currently ‘siloed’ extended access funding pots together, to form one funding stream and one extended access service.

‘We’ve got five years now, but within that, there are a number of reviews we need to do to make sure we create the right offer for the population, through the networks, and ensure it is something that is doable by practices,’ she continued.

According to NHS England, an average network with a population of 50,000 will be required to provide 25 hours extended access per week, which will be shared between morning, evening and weekends. NHS England said the DES will be delivered to 100% patients in every network compared to 75.7% at the moment.

Evening and weekend appointments have been gradually introduced since 2014, on the basis of a Conservative Party pledge which is now promising every patient will be able to book a routine appointment any day or evening by March next year. 

The Government and NHS England have continued to pump money into this scheme, with specific pledges being made in the GP Forward View, and CCGs given earmarked funding.

In all, the NHS has committed more than £200m of new investment for the next year, on top of £144m in 2017/18. More than £500m is due to be invested per year by 2020/21.

But Kent LMC vice-chair Dr Gaurav Gupta said: ‘We need to focus our energy on making sure the core services are sustainable, especially in regards to workforce.

‘Extended access needs to be what’s required, rather than just providing access for the sake of access, which has happened in the past. When we look at the utilisation of sunday appointments for example, they are not being utilised, and the workforce is quite limited to provide them anyway, so what happens with extended access is it takes GPs away from core services.’

‘If there is going to be a review, it needs to take into consideration the workforce, and ensure it does not destabilise practices’ core hours. It should be what the patients use and what is needed, rather than a blanket policy,’ he added.

A Pulse investigation previously revealed that around 25% of evening and weekend appointments are left unfilled, with take-up being the lowest on Sundays, when 37% of appointments go unfilled, followed by Saturdays at 24%. On weekday evenings, 23% of slots go unused.

Viaduct Stockport GP federation chair Dr Jaweeda Idoo said she is concerned workforce issues might prevent networks from fulfilling their requirements.

She said: ‘My biggest concern is that we won’t have enough workforce to deliver the outcomes that we want.

‘Our responsibility within networks is not just to offer extended hours, which is quite politically driven, it’s about offering what the population needs.’

Last month, the GP partnership review found extended access services entice GPs away from practices, as the work is ‘easier’.

The new primary care networks – which will cover 30,000 to 50,000 patients and be led by a local GP in a clinical director role – will see practices receive an average increase of £14,000, just for joining a network.