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Longer GP opening hours needed to boost productivity, says Monitor

GP should open longer and expand their surgeries to take on an additional 16m appointments from hospitals and plug a £30bn NHS funding gap, Monitor has said.

The health regulator said that GPs should be asked to increase their productivity by 10% to 20%, enabling them to see an extra two to four patients a day.

In a report out today, it said that by revising the appointment system, changing job roles and using telephone triage and telephone appointments GPs could free up time to do this.

The report comes after the Government announced pilots of extended access in the evening and at weekends with the aspiration of extending GP hours nationally.

The report, titled Closing the Gap, also said consolidating GP practices to reduce running costs and make better use of estates could save the NHS between £200m and £300m annually.

Monitor predicted that the NHS will face a £30bn funding gap by 2021 and listed a range of saving and productivity measures that could make up the difference in the report. Overall, Monitor suggested primary care could save between £1.2bn and £2.5bn annually just by improving productivity.

The document said: ‘Increasing the size of GP practices, reducing running costs and making more use of the estate, for example, by having longer opening hours, could improve asset utilisation for GPs’ practices. Consolidating practices will not always be feasible or even desirable in some areas. But new forms of collaboration between practices could deliver similar advantages. For example, smaller practices could collaborate to form networks serving 50,000 to 70,000 people. This would maximise the use of skills, co-ordinate care better and increase capacity.’

It adds: ‘Operational improvements in general practice could be achieved through a combination of revising appointment processes, changing job roles within primary care and using telephone triage and telephone appointments. Taking such measures could enable a typical practice with an average list size of 6,500 to add an extra 50 to 95 appointments a month. Measures to rework appointment and diagnostic processes could also free up GPs’ time, allowing them to focus on more complex patients and help meet future demand. The gains for patients from these measures could be considerable.’

However, Monitor also suggested GPs practices could take on an extra 10-16 million patients currently treated as hospital outpatients.

The report said: ‘Shifting outpatient activities to primary care settings, where they could be delivered by GPs with a special interest could realise gains of £0.7 billion. An estimated 10 million to 16 million outpatient attendances in hospitals could take place in primary care.’

David Bennett, chief executive and chair of Monitor, commented: ‘Over the next eight years, the health sector faces its greatest financial challenge in recent times. We are all going to have to strain every sinew to meet it. While there are individual things the sector can do - like be more efficient in its procurement or introducing new ways of working in hospitals - what is required is a step-change. In short, the NHS must undergo radical change if it is to survive. Monitor, as the health sector regulator, will not only be supporting, but actively enabling changes that deliver better services for patients and reduce costs.’