New proposals for extended working hours for GPs have provoked a storm of protest - but doctors should take a careful look at the benefits, argues Alastair Henderson
There has been a lot of noise in the national and trade media about proposals to change the GP contract from April so that patients can see their doctor at a time that suits them better - whether that is earlier in the morning, in the evening or on a Saturday.
Extending GP hours is a key pledge and a priority for Gordon Brown's government and was therefore an important part of NHS Employers' negotiations with doctors over this year's general medical services contract.
Let's be clear, opening hours are an issue for patients and the public. Research suggests that, while many patients are happy with the access they have to their doctor, a significant number want appointments outside traditional hours. The service is simply not addressing the needs of around eight million patients on this.
After months of negotiations, NHS Employers made an offer to the British Medical Association's GPs Committee late last year, proposing changes to the contract we believe take us a long way towards meeting this need. The committee is polling its members in the current weeks before formally accepting or rejecting the deal.
Separately, the Department of Health has started a consultation about alternative proposals to impose changes if the BMA's members reject the offer. The government needed to start the required 13-week consultation period on these proposals now, as changes to GP contracts need to be in place by 1 April.
The BMA has been vocal in expressing its concerns about the government's approach and the implications of the extended access proposals. Less has been heard about the potential benefits for patients, the service and, indeed, doctors themselves.
Our offer to the committee does not force doctors to extend hours but will reward those who do.
Pay for extra hours
Our proposal offers practices payment of£2.95 per 1,000 registered patients for providing 30 minutes' additional appointment time. This would equate to an extra three hours per week for the average practice.
The precise details of extended opening would be agreed between a primary care trust and its practices but should follow the preferences of patients locally. The expectation is that this will be on Saturday mornings and weekday evenings.
The funding will come from money released from some directed enhanced services which end in March.
We have also made an offer of a minimum of 1.5 per cent investment in general medical services if the deal is accepted. This means that if the final pay uplift applied to the contract by the doctors and dentists review body is less than 1.5 per cent, the balance will be made available for investment through the services.
Finally, we have proposed recycling 58.5 points in the Quality and Outcomes Framework in order to incentivise swift and convenient (48-hour and advanced booking) access.
The reward will be based on patient satisfaction, as measured by a new national patient survey or through modified practice surveys. No clinical areas have been removed from the framework.
NHS Employers believes this deal is good for patients in that it provides opportunities for the extra access that many people are seeking. It is good for PCTs in that it allows them to improve services for their local population. But it is also fair to doctors in that it rewards them for extending their hours.
I hope GPs will indicate their support for the contract when asked by the committee for their views.
Faced with conflicting views about what the general medical services contract should look like, there is no doubt that contract changes will continue to present a challenge for negotiators on both sides, in terms of balancing the views of PCTs, doctors and the priorities of the DH.
What is clear is that the GP contract should continue to deliver value for public money. This is something that all negotiating parties have agreed and we will continue to seek this in future iterations of the contract. The challenge for now remains to seek agreement with the committee on changes for April that will ensure that we do just that.
Alastair Henderson is director of operations at NHS Employers.