'Pay practices to open late' say GPs

The GMS contract may be altered to extend GP working hours by a new Brown government. Joe Lepper reports.

Among the media's attempts to predict the future of the UK under the premiership of Gordon Brown are some worrying stories for GPs surrounding out-of-hours care.

A key pledge being made by the chancellor is that if he becomes prime minister he will look to boost access to out-of-hours care, saying he wants to move the NHS 'into the modern era' and ensure services are 'there for people when they need them'.

On the surface this is no different from successive pledges made by ministers to address out-of-hours access since GPs were given the option to opt out under the new contract.

However off-the-record briefings by Mr Brown's allies have revealed that he is targeting GPs, in particular, to boost access. Some of the ideas coming from the chancellor's camp would undermine the foundations of the new contract itself.

Plans understood to be under discussion by Mr Brown include adapting the GMS contract to include evening and weekend opening and, more worryingly, scrapping the MPIG and using the money as part of an incentive scheme to encourage practices to take on out-of-hours work.

One report in the Daily Telegraph said that health minister Andy Burnham was now actively picking through the GMS contract to see how it could be altered to ensure more GPs worked more hours.

The DoH has sought to play down the reports, with a spokeswoman referring to them as 'mere speculation'.

Even if the reports are speculation, GPs already left battered by a second successive pay freeze are understandably concerned that they may be forced to work extended hours under a Brown government.

Dr Greg Place, chairman of Nottinghamshire LMC, is fearful that 'if they want to alter the contract I'm sure that legally they will find a way to do it'.

But he said such a move 'would be foolish without negotiation and would anger GPs'.

He said there was scope to extend practice opening hours, but by boosting investment in primary care, rather than altering the contract.

In his area, Nottinghamshire County Teaching PCT has invested in an extended opening local enhanced service. Dr Place's practice is among those that have taken it up.

Dr Place said: 'This is being run as an additional service which was offered by the PCT and so the cost of it comes from outside the practice.

The additional staff also come from outside the practice, although one of our partners is there.

'We only run it on a Monday evening with one of our GPs in-volved. But if you add up the cost of every surgery offering this five nights a week, the costs are enormous. Offering this as an additional service is a way to increase access to out-of-hours care but is something that will require significant investment.'

Meanwhile, Derbyshire County Teaching PCT is one of several trusts that are looking to increase access to out-of-hours care through APMS contracts.

Earlier this year the government announced a significant roll-out of the contracts, which are open to private providers as well as GPs, with many including extended opening from 8am to 8pm as a condition for applying.

Derbyshire LMC secretary Dr John Grenville said: 'Our PCT was not interested in creating an enhanced service, instead it is putting in place APMS contracts and saying to people that you can only go for them if you are prepared to work early mornings and evenings.'

Despite the lack of money being offered for extended opening hours, a handful of practices in each LMC area reportedly carry out the work for free.

Kent LMC secretary Dr Mike Parks said that this had occurred in his area.

He said there that many more practices are willing to work extended hours, but only if properly funded. Many would welcome the option being offering in Nottinghamshire, he said.

Dr Parks said: 'If Gordon Brown wants GPs to be involved more in out-of-hours care it can happen. There are GPs who are willing to do the work, but only with proper funding and that extends beyond paying for the practice to stay open. Also it is important that they are not forced into it. If they want us to do it then offer us a deal.'

Dr Parks warned that that was unlikely in the current financial climate because the cost, including ensuring back-up services are also available out of hours, would be too much.

He added: 'What I hope does not happen is they look to alter the new contract without negotiation. Many GPs signed up to it because of the changes regarding out-of-hours work.

'That is why young doctors are seeing primary care as a more attractive career path. To alter it would have a serious impact on recruitment and retention.'

WORKING HOURS

  • GMS in-hours period: 8am-6.30pm weekdays.
  • APMS in-hours period: 8am-8pm weekdays, 10am-2pm Saturdays.
  • Source: GMS/APMS contracts.
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