Practices subsidise extended hours services

GPs say official costings for extended hours DES are based on out-of-date information.

GP leaders say detailed costings released by the DoH show that practices are subsidising extended opening hours.

The calculations behind the extended hours directed enhanced service (DES) show old data on practice staff and salaried GP pay was used to estimate the cost of opening for an extra three hours a week.

They make clear that although the DoH recycled £158 million of funding from the 2008/9 access and choice DES to pay for extended hours, much of this will be lost to GPs in 2009/10.

The DoH priced the extended hours deal based on all practices taking part, splitting the £158 million across all 8,300 practices in England.

But ministers then set a target for only half of practices to offer extended hours. Fifty-eight per cent are now doing so, but this leaves 42 per cent of the funding lost to practices.

Estimates of salaried GP pay in the DoH costings are based on 2005/6 rates of pay. The calculations allow £60 an hour for salaried GP time, based on annual pay of £46,905 plus 21 per cent employers' costs and an additional 10 per cent.

'It's too low,' said National Association of Primary Care vice president Dr Peter Smith.

Salaried GPs now earn £60,000-£70,000 a year, before employers' costs are taken into account, he pointed out.

NHS Alliance GMS contract lead Dr David Jenner said that the costings set out by the DoH were enough to cover evening opening. But he added: 'Does it add up for opening Saturday mornings? I would say not.'

He said extending hours in the evening added marginal costs, but Saturdays meant heating premises from scratch and additional travel costs.

The DoH documents show that officials considered a model for delivering longer opening hours that included appointments with practice nurses.

Dr Jenner said the DoH should have let practices use this alternative model.

Staff pay
DoH estimates of practice pay

To cost extended hours, the DoH used the latest available data for partners (2008/9), salaried GPs (2005/6), practice nurses (2005/6) and admin staff (DoH admits data is 'old'). It added 21 per cent employers' costs and 10 per cent for direct revenue overheads.

Hourly rates

  • Partners £80
  • Salaried GPs £60
  • Admin staff £15

DoH extended hours costing

  • GP three hours per week £180-£240
  • Receptionist three hours per week £45
  • Total per practice per week £225-£285
  • Plus 25 per cent for unsocial hours payments, per week £281-£356
  • England cost per annum (based on 8,300 practices) £121.2m-£153.4m
  • Funding available for extended opening as result of access and choice directed enhanced services ceasing in 2008/9 = 158m

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