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by Cathryn Bateman
11 December 2007

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Put patients first – but don’t forget the practice or the purse

It seems everyone is talking about out-of-hours – or should I say extended opening hours? Let’s not get the two mixed up, as GP out-of-hours is gone, and is now well and truly the responsibility of the primary care trusts (PCTs) and the ministers who thought they could do it both better and cheaper.

Extended opening hours, well, that’s a different kettle of fish, and with a potential Tesco looming on the horizon of every town and village, I guess general practice has to remain competitive and move with the times in order to accommodate the needs of its patients.

First do the sums
However, like any business, we do need to get things straight and do our sums first. If anyone tells me that my practice can extend its opening hours for just £6,000 per year, then I would have to reply that it is impossible. No, hang on, let me rephrase that: it is possible, but it relies on goodwill and no extra pay for the health professionals involved.

It also relies on the practice having the infrastructure to support this notion. Even if I could persuade a GP to rearrange his/her working pattern, it’s not that easy to provide the support staff, because if I take one cog out of the wheel, then the cart will cease to operate. And that is because every person who works in our practice is valuable.

We have no flexibility with our staffing levels – we just don’t have the luxury of a bottomless pit of money to enable us to do that. So while some patients may get the benefit of extended opening hours, others will not and will actually suffer, since the GP they want to see will not be in that morning as he/she is working a late shift. It doesn’t help the 80-year-old who always sees that particular doctor, and who doesn’t want to come out in the dark. So let’s not think its all going to be plain sailing here.

Please be patient
Why are we even considering this, I ask myself? Well, it’s to respond to the needs of the patients of course, as taxpayers. I am sure that almost every patient survey around the country has cited access as an area for improvement – and, of course, because the survey says so we will all sit up and take note. Quite rightly too, some might say, as all of our earnings come from public money.

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But I don’t see anyone else who gets paid from the public purse being quite so accommodating to meet the needs of its public. Take education for instance. My child’s education hasn’t been tailored around the needs of the parent who is at work helping to sort out the health needs of the locals – if I am late from work her schoolteacher doesn’t stay in class and give her extra tuition. Why? Because she doesn’t get paid for it and we don’t expect it. So why should it be all give and no take?

Appreciating value
General practice has taken a real beating of late, and I for one think it’s about time people actually acknowledged the huge efforts of the professionals working in general practice, and appreciated the breadth of our workload. We have responded to the most challenging reforms, and have actually come out of them pretty well.

Because of this, I am sure we will respond to this one, but I do hope the negotiators don’t let us down, and that they come up with a professional fee for the provision of a professional service … after all, you don’t get a Rolls Royce by only paying the price of a mini!

But what do you think? We’ve launched a series of online surveys to gauge the consensus of opinion among practice managers on such topics (see surveys). The results from the first survey – focusing on morale and workload – will be announced in the next issue of Management in Practice.

Your comments: (Terms and conditions apply)

“Our practice offers access which is based on the wishes and  needs of our patients and meets the needs of the majority of  patients. The impact of ‘forced’ extended hours on this majority has not been considered at DH and government level. We are willing to offer some extended opening to facilitate patients accessing GPs where they are not able to attend in core hours, however the service delivered in primary care, which is what our patients want, may well disappear if we continue to have ‘one size fits all’. We are in danger in this country of losing the excellent primary care service which has been so highly valued by the patients, I include myself as a patient and user of the service, as well as being a practice manager who is proud of the service we deliver” – Meg Richards, Worcester

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