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GPC given ammunition to challenge Christmas Eve opening as study finds ‘negligible’ patient demand

Exclusive Just over one patient per practice contacted their GP between 4pm and 6:30pm on Christmas Eve last year, according to a new study that will be used by GP leaders to challenge NHS England’s stance on Christmas opening this year.

The report by Leicester, Leicestershire and Rutland LMC also found that less than one patient per early-closing practice contacted out-of-hours services between 4pm and 6.30pm on the two days.

Furthermore, the total number of patients who used any service in those hours was 54 – representing 0.01% of the total patient population.

The study concluded that the use of services was ‘negligible’ by patients listed with practices that stayed open until 6:30pm, as well as patients listed with practices that did not.

It revealed that there were only 21 total ‘contacts’ from patients from 4pm to 6:30pm among the 15 practices that stayed open, covering a population of 105,956 on Christmas Eve. This increased to 23 contacts on New Year’s Eve.

The out-of-hours service, which covered 46 practices that shut at this time, had a total of 33 contacts on Christmas Eve and 20 contacts on New Year’s Eve. It covered a patient population of 318,685.

The LLR LMC concluded in its report: ‘It is clear from the available data that the utilisation and demand for primary care medical services, at these two well documented troughs in general practice workload, is truly negligible. This patently highlights the extremely low demand that exists.’

The GPC last month had a ‘positive’ meeting with NHS England on the wider issue of in-hours closing. A spokesperson for NHS England said that the issue of Christmas opening will be discussed with GP leaders, and GPC negotiators said they will use the Leicestershire LMC study as evidence to push for a change in NHS England policy.

This follows the huge row between NHS England and GPs over opening hours during the Christmas period, with practices still fighting breach notices that were issued to them by the London and South area team for closing early over Christmas. This included one practice that could face contract termination for closing early on both Christmas Eve and New Year’s Eve.

NHS England had sent out national guidance to all GP practices stipulating they stay open until 6.30pm on both days, but many of its area teams around the country – including in the Leicester area – chose to honour agreements reached with local LMCs to allow practices to close and divert calls to a cover organisation.

The LMC’s executive medical director Dr Chris Hewitt said: ‘I think that it is good that we have some idea of the workload so that we can come up with some common sense policies that are based on information. It is helpful, and I hope that it will inform discussions as decisions are made for 2014.’

Commenting on the figures, GPC negotiator Dr Peter Holden said: ‘That is amazing, in other words it could have been easily handled by the out-of-hours service and the out-of-hours service would have got a reasonable amount of money for doing it.’

He added that NHS England’s stance ‘is about cost effectiveness and what this would have bought in goodwill would have been paid back in spades over the course of this year. Because it is little things like that which mean that staff are willing to go the extra mile when you’re under real pressure.’

Asked whether the GPC would be using the report in future talks with NHS England, Dr Holden said: ‘Yes we will, because it is evidence to back up what we already know. People will have to allow us to use our judgement.’

In Derbyshire, where Dr Holden is a GP, the area team decided practices could close early on Christmas Eve as long as they stayed open until 6pm on New Year’s Eve, which was accepted as ‘a fair compromise’.

However, Dr Holden added: ‘On New Year’s Eve we had two patients come through the door after two o’clock.’

Dr Mark Reynolds, a GP and the medical director at out-of-hours organisation Integrated Care 24, said there were sometimes problems with handing over to cover organisations for half days.

He said: ‘One of the difficulties for out-of-hours providers is actually getting payment for those half days, because actually you have to have a lot of doctors to cover an area for half-day closures. It is not actually so easy to just add another shift. The communication and the finances have to be clear, practices cannot just close and expect the out-of-hours service to pick up.’

An NHS England spokesperson said: ‘NHS England is currently working with the GPC and CCGs with the intention of developing a framework for practices and area teams to work to in considering the issue of meeting the needs of patients whilst recognising the pressures on practices. This will include consideration of opening hours at times such as Christmas whilst continuing to meet the reasonable needs of patients.’