GPC rejects DoH offer on extended hours

The GPC has rejected an extended hours deal offered by the DoH that would have added an extra three hours to the average practice's working week for no extra funding.

Dr Laurence Buckman
The DoH planned to stop the directed enhanced services for choice and booking and access and use this £158 million and the value of 58.5 quality framework points (£63 million) to fund this.

GP exclusively revealed in October that the DoH was bidding to take 60 quality points from the framework to fund extended hours (Bid to swap 60 QOF points for extended hours, GP, 10 October 2007).

The DoH wanted an extra half an hour of clinical time per week per 1,000 patients. This would mean an extra three hours per week for the average practice with 6,000 patients.

The DoH was also insisting that for practices with more than 3,000 patients, the extended hours should be in 90-minute blocks. This would make it easier for the DoH to meet its target of encouraging half of England's practices to open until 8pm.

The GPC was prepared to offer an extra 15 minutes of clinical and five minutes of administrative time.It wanted practices to be free to decide when they were able to offer extended hours.

The GPC suggested funding via the DESs but wanted the money attached to the bulk of the 58.5 quality framework points to be re-allocated for improved heart failure, osteoporosis and peripheral vascular disease care.

The GPC agreed a motion saying: ‘The GPC does not accept the government's current contract proposals. We will seek the opinion of the GPs of the UK.

‘We utterly reject the method of negotiating that uses gun-barrel consultation by threatening the imposition of more draconian measures on the profession.

'The GPC will now ask all GPs what their views on extended hours are. The GPC and NHS Employers have been in detailed negotiation since October on extended hours.

Dr Laurence Buckman, the GPC chairman, said: ‘We have done our utmost to come to a deal which would improve access for the minority of patients who are unhappy with the current arrangements, while at the same time trying to ensure it would not be at the expense of our most vulnerable patients, the elderly, the long-term sick and the very young.

‘We believe that the government's method of negotiation is nothing short of a disgrace. It has effectively put a gun to our head and said if we don't accept its proposal it will impose a more draconian contract. The vast majority of our patients, and in particular those with chronic diseases, prefer to come to surgeries during the day. They will be the ones who lose out if GPs are forced to work differently.

‘We are being bullied so that the prime minister can tick a box next to a politically driven target without regard for the damage this could do in the long-term to patient services in primary care.

'There are concerns that the DoH proposals would mean a deterioration of daytime services, place far greater emphasis on the wants of a small group of relatively well people and cause GPs to be tired and potentially unsafe.

The GPC is offering to continue negotiation with the DoH.Dr Buckman added: ‘We hope that the government will take up this offer and listen to us rather than force GPs to work in a way that reduces care for the majority.

‘If it is not prepared to accept our proposals, one of the few conclusions we can reach is that the prime minister does not really want to reach a deal with GPs. We could then assume that the issue relating to extended hours is really a smokescreen to hide the government's intent to privatise general practice as quickly as possible.'

Health minister Ben Bradshaw described the DoH's offer as ‘a good proposal that will go a long way to delivering the more convenient opening hours the public wants'.

He added: ‘We regret the BMA has not felt able to agree to it, but we hope GPs will. Because of the time required for consultation on alternative contractual changes we have to start that process now in case GPs are not prepared to support this proposal. Our strong preference is to work with GPs to improve access on behalf of the tax payer. The BMA is an important organisation, representing medical opinion in this country but it is important that on this issue they do not put the interests of their members ahead of the interests of patients.

‘The BMA's claim that patients who want to see their GP during the day will miss out is plain wrong. This proposal is about extending GPs' hours not limiting them.'

RCN nurse practitioner association chair Jenny Aston said: ‘If GPs do accept this, and I doubt they will, someone has got to do the extra work. It will cost more money to pay people for working extra hours. At my practice we open until 6.30pm - if we had to open until 8pm we would have to employ more staff.'

She pointed out that patient surveys had not demonstrated demand for longer opening hours.

‘I don't think the DoH has the evidence to show that patients want this. And I don't think there is a patient benefit from it - it is just to make the political people look good.'

She warned that GPs and nurses may ‘vote with their feet' if the DoH imposed a deal.

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