GPC warns that extended hours mean 12-hour days

GPC advises continuing to withhold appointment details from PCTs.

GPs face working 12-hour days under the new extended hours directed enhanced service (DES) in England, according to the GPC.

Practices will not be allowed to move consultation time from the day to the evening or weekends to give GPs time off.

Further details of how the extended hours DES will work were released after GPs reluctantly accepted the DoH offer.

GPC chairman Dr Laurence Buckman hopes that PCTs will be flexible, so GPs can achieve extended hours by reorganising existing appointments.

The GPC is therefore still advising practices not to participate in a PCT audit of the appointments they offer. This will make it harder for PCTs to assess if GPs are working fewer hours in the day when the extended hours DES starts.

GPC deputy chairman Dr Richard Vautrey said a lack of flexibility in the current agreement meant GPs would be working from 8am until 8pm. 'Tired doctors are more likely to make mistakes,' he said.

The agreement with NHS Employers was announced alongside results of the GP poll of opinion, which showed 97 per cent of, GPs lacked confidence in the DoH handling of the NHS.

The poll also showed an overwhelming majority of GPs (98 per cent) thought the DoH's methods of negotiation were unacceptable.

Although 96 per cent of GPs were opposed to both options, 92 per cent voted for option A, which means the average practice will lose £18,000 unless it participates in the DES.

The new DES also does not allow for nurse appointments. 'We are concerned that patients are being told their surgery will offer extended hours appointments but they will be disappointed with the services under this DES,' said Dr Vautrey.

But Dr Buckman said it was 'time to draw a line under this' and encouraged GPs to talk with their LMCs and PCTs to work out how to implement the extended hours DES.

Scotland will begin work on implementing a slightly different version of the DES after discussions between primary care organisations and contractors establish local need.

Alastair Henderson, acting director of NHS Employers, said: 'I believe it should be possible to ensure people aren't working more than they should be.'

Extended hours DES in England

  • Practices will receive £2.95 per registered patient, taken from the former choice and booking and access DESs.
  • The DES requires that for every 1,000 patients, 30 minutes additional consultation time must be offered outside core hours.
  • Consultation time must be in blocks of 1.5 hours, except where PCTs agree one hour prior to 8am is suitable.
  • This equates to 6-7 consultations per 1.5 hour block. GPs cannot work together to fulfil these requirements in a shorter space of time (except in very large practices).
  • If a practice currently closes for part of the day this does not have to be made up before extended hours can commence.
  • Practices already offering consultations outside core hours will be able to count these towards the DES.
  • Nurses will not be recognised under this DES. Payment will be quarterly; list size will be calculated on 1 April 2008.
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