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Feature: Open all hours

25 August 2014

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With practices under pressure to open for longer, we explore what implications this will have for staff and patients

In April, Prime Minister David Cameron committed to offering 7.5 million people increased access to their GP services through extended opening times and new consultation methods using videophone services, email and phone.

Launching the £50m GP Access Fund he said that patients at 1,147 GP practices across England will now be able to see their family doctor outside of working hours, including late night and weekend appointments.

It was originally thought that around half a million people would benefit from the cash pot but due to high levels of interest the Department of Health (DH) decided to roll out the scheme to cover more GP services.

Launching the Fund Mr Cameron said: “Back in October, I said I wanted to make it easier for people to get appointments that fit in around a busy working week and family commitments.” 

“There has been a great response from doctors, with lots of innovative ideas, and we will now see over seven million patients given weekend and evening opening hours, alongside more access to their family doctor on the phone, via email or even Skype.”

And with figures showing that over half of all clinical commissioning groups (CCGs) actively planning to commission extended hours – above and beyond NHS England’s extended hours DES and the central pilot pscheme announced by the Prime Minister – or are considering doing so, where does this leave practice managers?

Research published in July showed that six in ten managers already feel pressured to work additional extra hours.

Figures from the Institute of Leadership and Management (ILM) found that 94% of managers work over their contracted hours each week, with the majority (65%) feeling pressure from their organisation to do so. 

Forty four per cent of managers felt “direct pressure” from employers to complete additional hours for free and more than half (53%) of the 1,000 survey respondents reported that excessive workloads are the most common reason for working extended hours. 

Forty seven per cent of employees clocked an additional 7.5 hours or more, with 13% working two days extra on a weekly basis.

Charles Elvin, chief executive at the ILM said: “When you add up all the skipped lunch breaks, early morning conference calls and after hours emails you see just how widespread the extra hours culture is within UK business. 

“Of course, all organisations face busy periods when employees will feel motivated to work above and beyond their contractual hours.

“But excessive hours are not sustainable – there are only so many times you can burn the midnight oil before your performance, decision making and well-being begin to suffer.” 

Gary Hughes, practice manager at the Waterfield Practice in Bracknell, is realistic about what extended hours and opening times means for practice managers and practices in general.

“Our locality has been very slow to move on extended hours but I envisage that there will definitely be an increased workload,” he says.

“A rough audit of staff at our practice has already shown an unwillingness to do extra hours and anecdotally I have heard similar things from other practices in our patch.”

Mr Hughes is concerned that it will also be difficult to recruit both the extra GPs and practice administrative staff to get extended hours off the ground. “I think getting people interested will be very difficult as it is not just a case of moving to weekend working but evenings too, and recruitment for GPs and practice nurses is already very tough in this area,’ he admits.

Mr Hughes believes that implementing extended hours to all general practices nationally is “doable” but the scheme needs more time and much greater financial investment than is currently available to bring it to fruition.

Nick Nurden, business manager at the Ridge Medical Practice in Bradford, is more optimistic.  

“When we recruit reception staff we already put into their standard contract that they may be required to work extended hours including evenings and weekends,” he explains.

“We need to offer extended hours because it nets the practice £48,000 extra funding per year… we have to take income wherever we can get it” he adds.

However, he speculates that such funding will be withdrawn under the next government and practices will not be incentivised to offer extended hours.

“I think whoever the next government is they will include 8am to 8pm working in the standard contract, it just remains to be seen whether they will put adequate resource into this or just try and spread existing funding even further.”

Until recently he says, the practice had also been able to get salaried GPs to volunteer to work extended hours although he has now seen a rise in the number of extended hours sessions that the practice partners are having to work.

“Although partners tend to be in the practice at that time anyway they are normally catching up on paperwork but now they are seeing patients too.”

And he admits that the practice partners are currently questioning whether their current workload is sustainable.

“At present the partners work eight sessions and that is considered full-time, we are discussing whether this needs to rise to nine or ten and what this means in terms of juggling a work/life balance.”

He also says that it is becoming increasingly impossible to employ more salaried GPs because “they hold most of the cards and have ridiculous salary expectations.”

The government’s plans mean that GPs will not just be expected to open from 8am to 8pm on weekdays and to offer access on Saturdays and Sundays. 

The DH has said they will have to demonstrate that they will also test a variety of “forward-thinking services to suit modern lifestyles, including greater use of Skype, email and phone consultations for those who would find it easier”.

Jayne Tabor, a practice manager working across three practices in West Hampshire, says that ultimately there will need to be more investment to make this dream a reality.

“We need extra resources and financing of practices, we could not have more hours with the staff we have at present.

“If we extend our hours we also need other services to be available like tests and collections for lab work… it is all the extra bits that would need to be manned in the evenings and at weekends as well,” she explains.

Ms Tabor says that although she is in favour of offering 8-8pm and weekend hours in practices she believes that unless the Government commits to further investment the plan will fail.

“We can’t just spread out the staff we have more thinly, it just won’t work.”

For now it remains to be seen whether the Government’s plan of offering evening and weekend appointments to patients across the country is realistic without additional funding.  

Most practice managers would argue that it is not, and in trying, practice managers, practice administrative staff and indeed GPs risk reaching breaking point.

Take heed Mr Hunt.