The extended hours directed enhanced service (DES) may be redundant when it is published because most PCTs have developed more flexible local agreements, GP can reveal.
Data obtained by GP suggest that more than three quarters of PCTs have abandoned the DES in favour of a local enhanced service (LES).
|How LESs are driving extended hours|
Source: GP survey
Of the 63 PCTs that responded to a Freedom of Information Act request, just four were committed to using the DES alone or a LES based wholly on the interim DES guidance.
It is another sign of PCTs and practices rejecting national guidance in favour of local solutions, after two PCTs recently refused to build one of the GP-led heath centres the DoH wants in every PCT.
Latest DoH figures show that nearly 30 per cent of practices are offering extended hours, but the GP data suggests this is driven by local schemes rather than the DES. The figures also reveal that in some PCTs almost all GP practices are delivering extended hours.
GPC chairman Dr Richard Vautrey said PCTs developing more flexible LESs were being 'sensible and pragmatic'.
'As we have always said, practices and PCTs will see that the DES is not workable,' he said.
PCTs are offering flexibilities like those the GPC asked for during last year's negotiations.
The DES rules out concurrent working to deliver extended hours - one hour of extended opening must be delivered by a single GP working for an hour, rather than two GPs working in tandem for half an hour.
But Hull PCT is allowing concurrent working, to address safety concerns about GPs working alone after hours.
Walsall PCT and Eastern & Coastal Kent PCT included funding for practice nurses, meaning practices receive up to £4.95 per patient compared with just £2.95 under the DES.
PCTs have allowed practices to open in the morning rather than the evening, while Heywood Middleton & Rochdale PCT is reimbursing staff time rather than paying practices per patient. PCTs allow smaller blocks of extended hours, rather than the 1.5 hour minimum in the interim DES guidance.
Dr Peter Joliffe, chief officer of Devon LMC, said: 'Where people work well together it is likely the DES will be largely redundant in favour of a LES.'
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