Pressure on GPs to extend hours

It s gone 6.30pm, you ve just finished work and you want to see a GP. For many years this would have been impossible, but moves are being made to address the situation. Last week, Huntingdonshire doctors posed the question of how they could extend their h

It's gone 6.30pm, you've just finished work and you want to see a GP. For many years this would have been impossible, but moves are being made to address the situation. Last week, Huntingdonshire doctors posed the question of how they could extend their hours and ensure a quality service. ANGELA SINGER finds out what the problems are and what's being done.


DOCTORS were being rail-roaded into a change in their hours in the same way that the police were obliged to accept their pay deal, Ramsey GP Dr Patrick Byrne believes.

A doctor at Ramsey Health Centre, he was one of more than 100 doctors attending a meeting at Wood Green on Thursday called by the BMA (British Medical Association) and the Cambridgeshire Medical Committee (a mediation body) to discuss the changes.

The meeting was looking at how doctors could protest against the way the changes are being proposed, but events were overtaken on Friday when the General Practitioner Committee of the BMA decided to accept one of the Government's proposals.

Doctors will still be able to have their say during a poll to be organised by the BMA, but it is looking more likely that they will have to 'accept the better of two bad proposals'.

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The Government is calling on doctors to open their surgeries in the evenings and on Saturday mornings - giving greater access to patients.

However, among doctors, the proposals are seen as unworkable, and do not look at all of the access problems patients can have - daytime access on weekdays is not mentioned.

Some surgeries in Huntingdonshire had been negotiating with the primary care trust and patient groups to work out a way of giving patients greater access. They believe the Government ruined this process and replaced it with political spin, rather than patient welfare.

Dr Byrne told The Hunts Post that GP practices had accepted that changes would inevitably happen - the Government wants the changes introduced by April 1 - but there is contention about how.

"It is a matter of Hobson's Choice," he said. "People are a little bit upset because the Government is saying: 'If you don't accept our terms, then we will impose something even nastier that you will like even less'.

"There is no negotiation on the Government's plans, we either accept it or reject it and, if we reject it, we risk their imposing something worse."

The doctor said that precise details had not been worked out but, for example, a surgery may be expected to extend its hours by having one doctor working in the evening until 9pm.

"We have said we would prefer two doctors to work for an extra hour-and-a-half and call that three hours - but that is not acceptable to the Department of Health, the Government is saying it must be one block of time from one person."

Dr Byrne said the extended hours would be for people with appointments only and that doctors had been advised they would not be obliged to see emergency patients.

He added: "What if a patient wants to see a woman doctor? They might want to see the nurse. We might need to take a blood test. This has not been thought through. There is no provision to keep laboratories open so we will not be able to do routine tests.

"There will be no IT support after 6pm - all our patients' records are on computer so if the network is down and a patient comes in for their results, we might have to say: 'I would love to give them to you but our computer person has gone home for his dinner.'"

His colleague over at the Rainbow Surgery in Ramsey, Dr Arun Aggurwal, believes that the Government is practising "sound bite healthcare".

He said doctors were in favour of addressing access issues, but wanted to do so on their own terms and by involving their own patient groups.

Dr Byrne added: "There are some good points about the Government proposals. We agree with the principle but we question the how and the how long?"


Matthew Smith, assistant director of Cambridgeshire Primary Care Trust said talks had begun to see how to extend GP surgery hours.

"The PCT wishes to commission extended hours at times likely to be convenient for patients and has begun discussions with local practices regarding this," he said.

"It is too early to be specific about the outcome of these discussions as they relate to individual practices, but we look forward to working with clinicians to develop innovative initiatives within the resources available to us."


THE Government has put GPs in an impossible position, says the BMA.

The BMA's GP Committee (GPC) met on Friday to discuss the two options the Government has given GPs regarding changes to their contract and passed the following resolution: "The GPC has come to the conclusion that option A is less damaging for general practice, because the alternative option will harm the underlying fabric of NHS general practice and patient care more quickly and more lastingly."

It is not exactly an endorsement of the scheme.

Dr Laurence Buckman, chairman of the BMA's GPs Committee, added: "GPs have been put in an impossible position and will have to choose between two unacceptable alternatives. We have been asked which of these two is less bad and we have responded to GP demand that we do that.

"We are not recommending any course of action and GPs are free to come to their own decision on how to vote."


DR Arun Aggurwal said both Government options were the same when it came to extending hours. The basic premise is that extended opening would be for 30 minutes per week per 1,000 registered patients. This would need to be in blocks of 1.5 hours after 6.30pm or for one hour prior to 8am or on Saturday morning.

The difference is in how the two options are funded. Option A would take money away from the GP budget, but would allow them to claim some back by extending their hours. According to Dr Aggurwal, the focus is shifted away from clinical care.

If they don't accept A, Option B would be used. This would see £160m of funding removed from the GP contract and given to the PCT to increase access to GPs. However, Dr Aggurwal said this could be in the form walk-in centres or private practices.

There are also other differences in how schemes would be funded and checked.