The number of GP practices paid to offer longer opening hours dropped sharply last year, an HSJ investigation has revealed. The fall was particularly steep in poorer areas.
Figures from more than 3,000 GP practices across 60 primary care trusts show the number of practices offering extended hours as an enhanced service dropped by 7 per cent between 2010-11 and 2011-12.
But provision fell by 11 per cent on average across the 10 most deprived PCTs in the sample, compared with 2 per cent in the 10 richest PCTs.
Deprivation levels in the 10 PCTs with the biggest reductions in extended hours were on average a third higher than those with the 10 smallest drops.
The PCTs with the biggest proportional drop in provision are Hartlepool, Newcastle and Haringey, while those with the biggest rise in extended hours are Torbay, Barnet and Kingston.
See the full exclusive figures on extended hours provision, broken down by PCT, in the attached file on the right
HSJ’s figures show that 75 per cent of practices offered extended hours in the least affluent areas in 2011-12, compared with 88 per cent in the richest neighbourhoods.
A small number also provided extended hours through alternative provider medical services contracts.
The figures in the analysis are based on freedom of information responses, which have been compared with PCT-level deprivation indices.
HSJ’s sources blamed the fall on tightening finances. The findings come as six PCTs in inner-city areas begin piloting a scheme that allows patients to choose whether to register with a practice close to their workplace or home, in order to improve access to GPs.
Health secretary Andrew Lansley said this would help people to choose a practice that “suits their lives”.
Extended hours are defined as being beyond the core opening times of 8am-6.30pm,
Monday to Friday.
In 2011-12, the Department of Health reduced the money available to GPs providing extended opening hours under the nationally negotiated “direct enhanced service” from £3.01 to £1.90 per registered patient. However, it also relaxed the contract, meaning practices only had to open for an extra 30 minutes instead of 90. Appointments could also be offered by any healthcare professional, instead of only by a GP. The direct enhanced service is being offered under the same terms in 2012-13.
HSJ’s figures show that around two-thirds more GPs decided to take up the direct enhanced service in 2011-12 than in 2010-11.
However, the number of practices taking up the extended hours deal under a “local enhanced service” – negotiated between PCTs and GPs – dropped by three quarters, from 1,371 to just 327.
NHS Confederation deputy chief executive David Stout said this could be due to PCTs withdrawing the local enhanced service because they were too “strapped for cash”. In addition, he said some PCTs may have previously offered a local enhanced service for services that the more restrictive direct enhanced service did not cover.
He suggested the disproportionate drop in provision among poorer PCTs could be linked to this and the reduction of national access targets.
With less pressure on commissioners to measure extended hours and less money to encourage it, Mr Stout said it could be tempting for practices in deprived areas, which were more likely to be under-resourced and to have a greater proportion of single-handed practices, to opt out.
Mr Stout said: “Maybe when the pressure comes off, it’s harder for single-handed practices [to commit to extended hours] when no one’s making them do it and patients are used to going to A&E.”
NHS Future Forum chair Steve Field agreed tightened finances were likely to be affecting many inner city practices’ abilities to offer longer opening hours. He said: “There are more single-handed GPs in deprived areas and often to extend the hours when you only have one to two doctors in a practice is a real challenge.”
But he added: “It might be that in some of the deprived areas later opening isn’t what patients are looking for.
“The general issue is we need to build up the capacity in primary care and practices need to be responsive to what local patients need. Otherwise we won’t be able to deliver care outside hospitals.”
An NHS Hartlepool spokeswoman said extended hours provision was at “individual GPs’ discretion”. All its extended hours provision was through a direct enhanced service. No local enhanced service was offered.