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Er, how come we’re doing out of hours again?



‘I’ve just read the draft service specification for the new extended access service that CCGs will be commissioning from April 2018’ is probably the dullest opening to a blog you’ll ever read. But it gets better. Or worse, depending on how you look at it.

This, remember, is the enhanced service designed to have an all-singing, all-dancing general practice though late evenings, Saturdays and Sundays. Lack of space and editorial restrictions on expletives prevent me from articulating in full why this concept is a crockful of crap. Besides, you know this already.

But I would point out that, while the surrounding blurb insist that this is to be viewed as an additional service bolstering routine provision, ie, one which does not require patients to re-present during core GMS hours, the imperative to provide the service in large networks will, of course, achieve the exact opposite.

I’ll feel like an Extended Access Locum, because that’s what I’ll be, and therefore I’ll exert my locum’s rights to: insist on one problem per appointment, avoid ‘sorting patients out’, ignore QOF, refer indiscriminately or not at all and say, ‘You’ll have to see your usual doctor about that’ at roughly ten minute intervals.

The thing I really want to highlight, though, is a rather chilling clause tucked away mid-spec, which states that ‘Hub hours’ can be subject to change in view of patient demand, activity and A&E usage. You don’t have to be a conspiracy theorist to see the direction of travel here. In the immediate term it’ll mean being the CCG’s go-to for extra sessions whenever the hospital’s on red alert, that is to say, all the time.

And in the long run? There will come a time when we’ve become reliant on the income extended access provides and we’ve had various iterations of the spec moving though, say, provision of urgent appointments, expanding hours and home visits. We will surface from a weekend nightmare session, exhausted, rub our bleary eyes and exclaim, oh, look, we appear to be doing out-of-hours again!

Who saw that coming? Us, hopefully.

Dr Tony Copperfield is a jobbing GP in Essex