DoH considers dropping extended hours DES

Exclusive - Revised access deal could bring greater flexibility and more funding for services in England.

Dr James Kingsland

The DoH is considering replacing the extended hours directed enhanced service (DES) with a more flexible local alternative, GP can reveal.

Practices have criticised the DES for its rigid rules, which do not allow concurrent working or appointments with nurses.

But Dr Mike Warburton, director of the GP access programme at the DoH, said the department was currently circulating proposals for a model 'Responsive Practice' local enhanced service (LES) among PCTs. This 'may be in place of the extended hours DES, or may be on top of it', he said.

A DoH spokesman said that the NHS Primary Care Contracting (PCC) team was drawing up a model that PCTs could adapt to local needs. This would 'incentivise local practices to offer a more responsive and personalised service to their patients,' he said.

By way of example, he cited internet-based appointment booking, better telephone services and improved access for minority ethnic groups.

Dr Warburton also hinted that more money could be made available for access schemes, admitting: 'That GPs have to do it for no more money is an issue. It is a negotiation issue.'

A DoH spokesman could not say how the LES would be funded, and whether money would be taken from elsewhere in PCT or practice budgets. 'This is an idea that is still in the very early stages,' he said.

Dr David Jenner, GMS contract lead at the NHS Alliance, said he would welcome a genuinely flexible LES, adding: 'It's fair to say that the current scheme is pretty unworkable.'

But he warned that additional funding would be needed. 'I don't think you're going to motivate GPs to do more by moving around used fivers.'

Dr James Kingsland, president of the National Association of Primary Care, said it was 'oddly contradictory to have a national scheme for something that's supposed to be based on local priorities'.

He added that it raised questions about the DoH's faith in world-class commissioning. 'If you have to tell a commissioner how to develop a LES, they are not exactly world class, are they?'

The DoH said it hopes to publish details of the new LES on the PCC website in mid October.

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