Exclusive: How to open extended hours for £6,000

Practices can open extended hours for less than the value of 60 quality framework points, according to National Association of Primary Care president Dr Peter Smith.

Dr Peter Smith
Dr Peter Smith

Last week GP reported that the DoH plans to take 60 quality framework points, worth £7,476 to the average practice, from the clinical domain to fund extended hours.

Dr Smith has devised guidance on the costs of opening until 8pm four nights a week and from 9-11am on Saturdays. The annual cost of opening extended hours was calculated to be £6,032.

However, the figure is likely to spark controversy because it relies on GPs and nurses adjusting existing working arrangements to cover the extended hours at no extra cost.

Staff costs for a receptionist worked out at £4,472 per year, and additional infrastructure costs such as heating and lighting came to £1.560 per year.

GPs have questioned whether taking money from the contract and allocating it to work in hours outside the contract is legal.

The figure may ease concerns that 60 points is not enough to cover the additional hours. Doctors are alarmed by the prospect of a £7,500 pay cut if they do not offer the opening hours.

Dr Smith, however, said he had been running extended opening hours at The Churchill Medical Centre in Kingston, Surrey, for nine months and described it as ‘fabulous.’ ‘It has been incredibly well appreciated by the patients,’ he said.

‘It seems inevitable that it would feature in the framework. There is no great evidence it produces better clinical outcomes, but we are seeing a lot of males in the evening that we would not usually see.’

The guidance says the cost of extra hours ‘is worth every penny’ and flexible hours ‘can be liberating’. It also reassures doctors that no-one will have to work 8am to 8pm.

Dr Smith added: ‘It’s a nice thing to do. Saturday morning clinics are mostly worried mums that aren’t able to see someone during the week.’

The guidance was created in response to a large number of GPs calling for information about opening extended hours, Dr Smith said.

‘It was produced purely co-incidentally and just happens to have a cost figure near the one GP published for the framework points value,’ Dr Smith said.

His leaflet will feature a six-step plan on how to achieve a successful extended hours service.

However, GPC negotiator Dr Chaand Nagpaul said he did not believe that refusing to pay staff to work unsocial hours could or should be the basis for a national policy.

‘Under employment law you can’t demand it of them and I don’t think you can expect salaried GPs and practice nurses to offer to do this on a national scale when many of them entered the profession because it had family friendly hours.’

Dr Nagpaul said he was also deeply opposed to the use of quality points to fund extended opening hours because access was a local issue.

‘Every area’s needs are different. This should be determined at a local level and through local negotiation, not in a national, quality scheme.’

Fellow GPC negotiator Dr Stewart Drage said if GPs wanted to offer extended opening hours then they must make sure they consulted staff extensively as the contract bound them to ensure they were good employers.


How to run extended hours for £6,032
  • Receptionist cost:
    Six additional weekday hours = £60.
    Increased rate for two hours on Saturdays = £26.
    Annual cost: £86 x 52 = £4,472.
  • Annual infrastructure cost = £1,560.

Total = £6,032.

GPs and nurses working flexibly for nothing extra during these periods.

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