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PCNs must offer GP appointments across whole extended hours period


PCNs GP appointments


Exclusive PCNs will need to provide GP appointments covering the ‘full’ periods of 9-5 on Saturdays and 6.30pm-8pm on weekdays, NHS England has confirmed to the BMA.

Under this year’s updates to the network DES, GPs in England’s PCNs will be ‘required to provide Enhanced Access between the hours of 6.30pm and 8pm Mondays to Fridays and between 9am and 5pm on Saturdays’ from 1 October 2022.

It was previously unclear whether this means PCNs will have to provide appointments throughout the whole period rather than just within the stated hours.

But a BMA spokesperson has confirmed its understanding that practices will be expected to offer the service to cover the ‘full’ additional hours.

The spokesperson said: ‘NHS England and Improvement have confirmed their expectation that all PCNs will be required to provide appointments for the full Network Standard Hours, covering the hours 6.30pm-8pm on Mondays to Fridays, and 9am-5pm on Saturdays.’

They stressed that this is not the BMA’s position and that the BMA has been seeking amendments to the imposed GP contract, including a relaxation around Saturday opening times under the network DES.

An NHS England spokesperson told Pulse on background that they do not believe any formal clarification has been provided to the BMA but that they do not believe this to be an issue of contention.

They stressed that the DES contract was clear, that this position was confirmed when it was published and that NHS England’s position has not changed.

The DES also set out that the service does not have to be provided by a single practice, but can be shared out among PCN member practices.

It said: ‘A PCN must ensure that all practices in the PCN’s membership actively engage in planning of the provision of the extended hours access requirements and acknowledges that nothing in this Network Contract DES Specification requires an individual clinician or practice within the PCN to deliver a particular share of the appointments. 

‘The exact number of extended hours access appointments delivered from each member practice premises will be for the PCN to determine subject to complying with the minimum additional minutes.’

Appointments must be provided ‘in continuous periods of at least 30 minutes’, it added.

Meanwhile, the DES also said that if any PCN member practice is already providing appointments during the enhanced access time period, additional appointments must still be provided regardless.

It said: ‘If another core network practice in the PCN provided core services at its premises until 8pm, then: 

  • ‘any additional clinical appointments provided after 6:30pm but before 8pm must not be provided at the later closing practice’s premises (as these would not be additional hours appointments) but could be provided at the other practice’s premises; and
  • ‘a proportion of the additional clinical appointments must be provided after 8pm’

The BMA reiterated to Pulse that its GP Committee for England did not agree to the changes in the GP contract this year, meaning the DES specification updates have also been ‘effectively been imposed on the profession’.

GPC deputy chair Dr Kieran Sharrock said: ‘GPC England supports the principle of independent practices collaborating together, and with other providers, in their localities, but the DES is too restrictive and places too many burdens on practices.

‘We are aware that some practices are gravely concerned about the inflexibility of the programme, given ongoing staffing shortages, and the bureaucratic requirements associated with it.’

He reiterated that practices can opt-out of the DES ‘if they do not believe they can guarantee capacity within the staffing compliment they have’.

Dr Sharrock added: ‘The BMA remains open to discussion with NHS England and NHS Improvement about ways to improve the flexibility of the PCN DES, and ensure the programme works for every practice and its patients and realises our shared ambition of at-scale working for the benefit of all.’

It comes as the BMA said this week that NHS England has rejected its requests for certain relaxations of the DES, including around Saturday opening times and GP availability for the new extended hours service.

It has repeatedly encouraged practices to consider their ongoing participation in PCNs.

A Pulse survey last week revealed that as many as a quarter (25%) of GP partners are still unsure as to whether they will sign up to the 2022/23 Network DES.

What are the network DES enhanced access requirements?

The DES set out the requirements for PCNs to provide enhanced service access from 6:30pm to 8pm on weekdays and 9am to 5pm on Saturdays.

Under the requirements, networks will have to provide 60 minutes’ worth of appointments per 1,000 population within the network, delivered within the hours stipulated.

The appointments will be available ‘for any general practice services and services pursuant to the Network Contract DES that are provided to patients’, the DES says. It also says that they should be bookable a minimum of two weeks in advance, and that same-day appointments should be made available.

The service will go live in October, when it will be funded £7.46 per patient pro rata. Until then, networks will receive 72p per patient for the preparatory arrangements.

PCNs must submit plans to commissioners by 31 July, which will set out the mix of services to be provided, how networks will offer appropriate levels of face-to-face appointments and what locations are to be used.

This article was updated at 12.30 on 27 April 2022 to clarify the BMA’s position.

READERS' COMMENTS [18]

Dr N 22 April, 2022 4:50 pm

The recruitment crisis just got worse in one idiotic DES moment.

Patrufini Duffy 22 April, 2022 5:27 pm

You voluntarily opted in. For a compulsory shafting. Year on year. Watch your specifications run you out dry. It is voluntary – but your spine seems a bit wobbly. If you want the dollar (£$), then you must pay with sweat and monitoring. Do not complain for something that is opt-in. You know, NHSE is not someone to have banter with. They are coming for you, your data and have nicely herded you into an illusion of “working together” very cleverly. It is in fact “working to disintegrate you”. Your practice actually loses its autonomy and voice. I do admire them, for this almost check-mate move.

Bonglim Bong 22 April, 2022 6:17 pm

I agree with patrufini to a degree. I think that it is a totally opt in or opt out situation. If you think it is a good deal opt in, if not opt out.

If you opt out – make sure the magnitude of work you deliver is reduced to reflect the decreased funding, the decreased staff numbers and so on.

I personally think the numbers stack up pretty well and will be opting in – and wont be complaining about it. A 47000 patient PCN can have a a GP, nurse, healthcare assistant and receptionist working together for each of the 15.5hours and be paid £420 for each of those hours – to share between them.

Squamous 22 April, 2022 8:09 pm

For the 47,000 practice that would be 47 hours of extra appointments abou half of which would need to be provided on Saturdays.

Matt Hancock 22 April, 2022 9:58 pm

Bonglim Bong do you mind explaining you math?

Bonglim Bong 23 April, 2022 7:22 am

Squamous – you can offer just 8 of those 47 hours on the weekend if you choose. They do not have to be evenly spread – although in my example it is.

Bonglim Bong 23 April, 2022 7:43 am

Matty H – glad you managed to get a minute away from your assistant:

47000 patients would be 47000*£7.44 per patient per year = about £350000/ year
350000/52 weeks = 6724 per week
And you have to deliver 47 hours of work per week -which is the 15.5 core hours for 3 clinicians and a receptionist.

That is funded really well – as long as you can find the people.

Matt Hancock 23 April, 2022 10:30 am

Yes I agree with your numbers

15.5 hours of a locum GP= 90x 15.5
15.5 hrs of a reception=15 x 15.5
15.5 hours of a HCA/Nurse= 35 x 15.5
So that totals out at £2170

Lets say incidental costs are £170 that is a huge amount of money (2000 a week) Finding staff wont be difficult. You just need to increase rates and it will still leave a big chunk of money left for the PCNs.

Surely we are missing something

Matt Hancock 23 April, 2022 10:31 am

Sorry it should say around £5K in profit

Ian Jacobs 23 April, 2022 10:46 am

Hi Bonglim Bong : Can some of these “out of hours ” appointments be designated as a clinic ? eg diabetes/asthma /joint injections etc. That would enable QoF work to be done at the same time as meeting the enhanced access requirements. Running a specialist clinic would enable appropriate choices of nurses for these extra hours and extra QoF income help to pay for the increased staffing costs .

Presumably these clinics would need to be accessible to all practices within the PCN that have signed up for the network DES .

Comments would be appreciated.

Bonglim Bong 25 April, 2022 8:57 am

@Ian
Must be accessible to all patients within the PCN – that is absolutely clear.

And i think they must be pre-bookable/ prebooked (as you are not replacing the out of hours service, you are improving access for your core patients).
And I think they must be with patients. Not all of them have to be face to face – but they have to be patient appointments – you can’t use them for perhaps reviewing pateint notes without pateints to do QOF work. But you could use (some of) them to call patients who have been booked in for a remote QOF review. I don’t think they can all be remote.

But they absolutely can (in fact should) be some appointments for the types of appointments you said. The wording is something like the full range of surgery appointments. So bringing patients down for a diabetes or asthma clinic or joint injection is totally appropriate.

I think the theme is these are your regular appointments at a time that is easier for patients, not more acute care to take work of out of hours/ A+E or the ambulance service.

Bonglim Bong 25 April, 2022 9:00 am

@Matt H

You are right that is the approach we are going to take – to pay staff a lot of money to encourage them.
It might have knock on effects for staff availability in the week (in the medium term) Someone who currently works 4 days a week, might work 2 regular days and a Saturday in the future. If that happens around every GP surgery then there is going to be a shortage.

The reason the money is so high is it is a combination of the extended hours that most GPs did, which was not paid that well and the commissioned service for GP access at unsocial hours which had a very high payment.

Neil Paul 25 April, 2022 10:11 am

This makes no sense. what does it mean? i can offer 1 appointment at 9am on a saturday and one at 450 and im meeting the criteria?
does it mean we can’t stop consulting for lunch on a saturday?
we are currently open 8-630 core – i know loads of practices whose last routine appt is 450pm.
how is this going to be even monitored? im sorry you cant get paid as your last appointment was 430 not 459?

Neil Paul 25 April, 2022 10:27 am

Sorry wont let me edit a comment –
what if all my practices are willing to open all day saturday and do the 60mins but none want to open during the week – or opposite – they all open monday to friday but noone wants to do saturday? is it the number of mins consulting? or opening times? also – and im afraid to ask what if i give every patient a 30 min appt? will that count? what if i give mental health patients an hour each is that ok? completely stupid ES

Bonglim Bong 25 April, 2022 10:33 am

I agree Neil there is no advice on the length of appointments – so i think it is going to be a fair approach thing.
So I think 15 minute appointments on a Saturday is probably appropriate. Maybe 20.
But if you had two, 4 hour appointments – that may not be seen as acceptable.
But who knows how they will police it.

In terms of the weekday timings there are clearer rules. It is not related on what your normal appointment times are but core times (i.e. when your phone lines have to be open) – which for most practices are 8am-6.30pm – even if their last appointment is 5pm. So for those practices who’s last appointments are 5pm, they will not be able to start their out of hours components until 6.30pm.

There are clear rules for practices who’s core hours are currently later – mostly APMS practices. Those hours for those practices cannot be counted towards the out of hours total. They can if delivered at a different practice in the PCN.
There is going to be a grey area if they use another practice – to run remote consultations and someone sat within the APMS practice with late core opening hours is doing the consultations – but I suspect that is acceptable. It wont apply to us.

Bonglim Bong 25 April, 2022 11:12 am

@Neil
As usual I don’t think that they are unreasonable questions – but as usual NHSE have published everything without seemingly asking a GP partner what they think – or at least not listening to them. So none of those questions have been answered.

From what i understand:
– You need to hit the right number of minutes rather than number of appointments.
– But all the core hours need to be occupied – so someone must cover the Sat 9-5 hours and 6.30-8 mon-Fri evening – and there has to be at least one GP consulting through those times. That totals 15.5 hours.
– You can consult outside the hours stipulated as well – to help make up the total number of hours – but that needs to be agreed with the local commissioners.
– you could just have a GP consulting on Sat and make up the rest of the hours in the evenings if that is what you prefer.

In terms of minutes per appointment – it is just if you can justify it when asked. I think you have to present a plan by July – I have no idea how much detail that will have – but you could try to present the plan with 30 mins/appointment and see if acceptable.
Just like core hours some patients require more time – so for isolated patients I’d say it is fine. For every patient? I think I would want to include it in the plan – so that if they complained after you can say it was in the plan we presented.

If you had a mental health practitioner doing detailed mental health reviews – hour long appointments are fine. Perhaps if you specified that is what the appointment is for – you could have a GP delivering that service for your patients.

Kevlar Cardie 25 April, 2022 1:14 pm

Doubleplusgood : the thoughtpolice took my last comments down.

2+2 = 5.

Long live Airstrip One !!!!

Dylan Summers 26 April, 2022 10:20 am

My local OOH service is struggling to staff its GP rota. Routine GP appointments on a Saturday seems likely to worsen the shortfall.