Seven-day GP plan sparks funding fears

Plans to extend GP opening to 8am-8pm seven days a week are underfunded, and will undermine weekday services and drive up patient demand, GP leaders have warned.

A £50m funding package for piloting the scheme suggests practices will be expected to extend their hours for ‘less than the minimum wage’, one GPC negotiator told GP.

A senior GP commissioning adviser whose practice already operates seven days a week warned the proposed funding was ‘a huge problem’ if pilot practices had to support large populations.

Prime minister David Cameron announced pilots of 8am-8pm seven-day opening at nine sites across England at the Conservative party conference.

He said ‘pioneer’ practices will be invited to come up with ‘innovative’ schemes that enable patients to access GP services over these extended hours.

The BMA warned that without extra GPs, the existing workforce will be stretched over seven days, threatening weekday services.

Funding

GPC negotiator Dr Peter Holden believes the funding available for the scheme suggests GPs will be paid less than the minimum wage to open for longer.

The costs involved in extending opening from a 52.5-hour week to 84 hours would mean GPs were paid around £3 an hour for the extra time, he said. ‘The government is asking GPs to work for less than half the minimum wage.’

Dr Holden said the plans would ‘spread the workforce too thinly’ while there was already a ‘desperate shortage’ of GPs, with many already working hours that would be banned in other professions.

‘Why stoke up demand you can’t possibly fulfil?’ he said. ‘We’d like to if we could, Mr Cameron, but this is completely off the wall.’

The new scheme is a first step towards rolling out extended hours across the country, ministers said, echoing plans for wider access to GP practices rolled out by former prime minister Gordon Brown in 2009.

NHS clinical commissioning community lead Dr James Kingsland, who has been piloting a similar seven-day opening scheme, agreed that the government pilot proposals were underfunded.

Extended hours

He said £50m for nine pilots was a ‘huge problem’ if they were expected to offer extended hours not just for their own practice population, but for wider areas.

‘If it’s nine sites covering a huge population, you are just going to recreate another type of urgent care service run by a federation,’ he warned. His own model – 12 hours, seven days a week, with routine weekend appointments and urgent care for 5,000 patients – cost £35 a head, Dr Kingsland said.

Nationally, that would cost £1.75bn to £2bn for all practices, under 2% of the NHS budget. Dr Kingsland said that properly funded extended hours pay for themselves by making savings across other services.

Practices could also face costly planning and lease hurdles if they extend opening hours.

Nathan East, a commercial property specialist at law firm DAC Beachcroft, said premises problems could be a ‘significant fly in the ointment’. Dr Holden agreed difficulties with leases were a real possibility.

Planning authority and lease restrictions could be a ‘big obstacle’, said Mr East, and prove costly to challenge. ‘People are going to have to be alive to these issues,’ he said.

The current government’s plans will aim to reverse a trend of falling numbers of practices offering extended hours. In July 2012, a Labour party investigation found that almost 500 GP practices had dropped extended opening since the coalition government came to office.

A DH spokeswoman said: ‘We are not asking GPs to work 84 hours a week, but we are asking them to help us test new ways of working to make sure patients get better access. This could mean redesigning rotas or working in innovative new ways using technology. In some places, this is already happening.

‘We know GPs are under pressure, that’s why we have asked Health Education England to work towards getting 50% of medical students to become GPs.’

She said lease issues would be considered when the results of extended hours pilots were reviewed.

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