The government’s flagship policy for extending primary care access is pushing up the cost of GP shifts and destabilising existing out of hours services, several sector leaders have warned.

  • Prime minister’s challenge fund “driving up GP shift rates” for work outside normal hours, say GP leaders
  • Fund shifts more appealing because less stressful work and offer more pay, HSJ told
  • GP practice clusters reduce competition for staff, OOH leader says

The prime minister’s challenge fund initiative was launched in October 2013, with the stated aim of improving access to primary care. A first wave of participating practices receiving grants was announced in April last year. The policy was then extended to pay for a further wave announced in March this year.

Richard Vautrey

Local OOH shifts are often half that of the challenge fund sessions, Richard Vautrey said

It aims to extend access in a variety of ways, such as developing the use of technology, but a core element is extending opening hours to evenings and weekends at some surgeries. The initiative currently covers 57 sites with a 18 million total population. The government plans to expand it further.

Several primary care leaders told HSJ that in areas covered by the initiative, it was driving up shift rates for GPs to work outside normal hours. This was leaving existing out of hours primary care services struggling, they said.

British Medical Association general practitioners committee deputy chair Richard Vautrey, a GP in Leeds, said out of hours services were being destabilised by the fund at most of the sites, where “rates of pay for a session in the local OOH service are often half that of the [prime minister’s challenge fund] session”.

He added that shifts for the challenge fund initiative were “a lot less stressful” for GPs, because they normally involved routine appointments rather than a “typically busy urgent care session” in an OOH service.

“This has exposed the chronic underfunding and rising workload pressures of out of hours sessions and it’s why we have consistently been calling for the millions being spent on the PMCF to be focused instead on providing a better GP urgent care OOH service,” he added.

The GP leader of one OOH service in an area in the north of England which is part of the challenge fund initiative, who did not want to be named, told HSJ that GPs with a choice between a “four hour session that is full-on or a four hour session in a practice and getting paid more” were choosing the latter.

He added: “Where are the GPs going to come from? We’ve already got a problem with [paying for indemnity insurance for out of hours GPs] and a changing workforce. The last thing we need is someone saying they’re going to go for the same staff.

“My worry is we’re destroying Peter to pay Paul for doing bugger all.”

Ian Winstanley, chief executive of Shropshire Doctors OOH, said there was an “element of truth” to the concerns because in some areas “there seems to have been almost a bidding war which has taken place which has forced the cost for a GP session in some places quite dramatically”.

However, he said the “vast majority” of challenge fund areas were providing extended opening hours across clusters of practices, rather than at each one, which reduced the competition for staff.

The Department of Health had not responded to HSJ’s request for comment at the time of publication.

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