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GP services must expand into evenings and weekends under NHS England plans


Standard GP opening hours should be increased by an hour and a half per day on weekdays, and extended to Saturdays and Sundays as standard, under a major access drive announced by NHS England yesterday.

An annex to the national commissioning body’s 2016-17 planning guidance, published on Thursday, stated that extra funding for the change will be rolled out to local clinical commissioning groups from next year, covering all of them by 2019-20.

The document stated that CCGs must make plans to extend GP consultation hours, covering the following requirements:

  • Offer weekday provision of access to pre-bookable and same day appointments after 6.30pm to provide an extra hour and a half per day.
  • Commission pre-bookable same day appointments on both Saturdays and Sundays “to meet local population needs”.
  • Provide “robust evidence” for which services should be available throughout the week.
  • Ensure uptake of the expanded services is automatically measured using a new tool to be introduced next year.
  • Use “digital approaches to support new models of care” in general practice.

CCGs should commission at least an extra 30 minutes of GP consultation time for every 1,000 people in their populations. It is intended that this should eventually rise to 45 minutes per 1,000 population.

The guidance says appointments can be provided on a “hub basis” with practices working at scale. The multispecialty community provider policy framework published in July this year specified that primary care hubs should cover populations of 30,000-50,000.

Offering this expanded access will make CCGs eligible for additional funding: in 2017-18, an extra £6 per head of population will be available to CCGs running increased access schemes under the GP access fund – previously known as the prime minister’s challenge fund.

The total funding available to CCGs to pay for increased access will be £138m in 2017-18, rising to £258m – or £6 per head of population for each CCG – in 2018-19.

The planning guidance states that NHS England will give cash terms funding increases to primary care over the next two years. Its guidance confirms that NHS England has allocated around £8bn in 2017-18, an increase of £301m over this year, and around £8.3bn in 2018-19, a further £304m uplift.

Details of improved GP access approaches must be included in GP forward view plans that CCGs are required to submit by 23 December.

These plans must also include, “as a minimum”, how funds for practice transformational support will be created and deployed, how funding devolved to CCGs for online consultations and training of care navigators and medical assistants will be deployed.

The planning guidance also includes a set of new measures intended to improve communications between GPs and the rest of the NHS:

  • Letters will have to be sent to GPs following clinic attendance faster in future. The current target of 14 days will be cut to 10 days from April 2017 and seven days from April 2018.
  • A new requirement for letters to be sent electronically in a standardised format will take effect from October 2018.
  • GP referrals must be made electronically from April 2017, and trusts will not be paid for non electronic referrals from October 2018. NHS England has pledges to work with GPs to resolve “practical issues” which currently hinder use and uptake of e-referrals.

CCGs should also have a “clear, articulated vision” of what redesigns will be needed, as part of local sustainability and transformation plans. This should include details of how greater use will be made of self-care, technology and the wider workforce, and other actions to address GP capacity.

Details of improved GP access approaches must be included in GP forward view plans that CCGs are required to submit by 23 December.

The planning guidance for commissioners also sets out details of how CCGs are expected to implement funding promised in the GP Forward View document.

Such provisions include plans “to spend a total of £3 per head as a one off non-recurrent investment commencing in 2017-18”. CCGs will not receive extra funding for this and will need to find the money from core service allocations.


Readers' comments (2)

  • Bearing in mind that a lot of GPs and primary care nurses are part-time women with young families, and therefore will not want to work at weekends, how does the DH propose this is staffed? If female primary care clinicians are required to work weekends as part of their contracts, I can quite see large numbers dropping out entirely from GP work for significant periods of time. It also has to be realised that weekend work cannot be additional to existing five-day working: those working at weekends will need to have time off during the normal working week.

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  • I'm a Practice Nurse, with what staff do they propose we cover evenings and weekends? We (nurses and GP's) can barely cover the workload for 5 days a week. If they want weekends covering then they will have to accept that services in the week will reduce.

    Interestingly we did open for a a couple of years on Saturdays, the DNA rate was horrendously high and most patients said they didn't really want appointments at the weekend as they had other plans! We therefore dropped the Saturday clinic due to lack of demand!

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