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Extended hours - BMA's fight to defend general practice goes on

February 2008

The BMA’s General Practitioners Committee (GPC) met on Thursday, 7 February, to discuss the BMA’s ongoing response to the Government’s proposed changes to the GP contract in 2008 and the threat to impose alterations to the contract if GPs do not accept the Government’s current offer.

GPC confirmed that later this month a poll will be sent to all GPs in the UK to seek the views of the profession on the governments' proposals. Details of the proposals in all four countries will be clarified and sent out with the poll documents. The GPC will continue to work with NHS Employers to clarify the details of the options and the wording of the extended access DES and continue to seek improvements to the DES.

The GPC debated and passed the following motion:

"That 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 more quickly and more lastingly."

Further details of the poll and the implications that option A and option B are likely to have on the profession can be found in a letter from Dr Laurence Buckman of 12 February.

The GPC continues to have serious concerns about Option A and that GPs are having to select from two options, both of which it considers unacceptable. However, it was decided that the committee should take a view on the options as many GPs were asking for the GPC's opinion in advance of the poll.

The GPC reached its view after an assessment that, whilst both options were highly undesirable, Option B would remove significant amounts of funding from the contract, particularly through the permanent removal of 135 QOF points, and would not guarantee that the governments would not try to do the same next year. The negotiators believe future negotiations would be more difficult if Option B was to be the final outcome and would not result in the Department re-opening negotiations. It was felt this was not the ideal battleground on which to engage and the public debate needs to be focused more widely on the threats from the increased privatisation agenda and the implementation of the Darzi proposals, rather than on extended hours.

Of particular concern with Option A is the rigidity of the DES for extended hours and the way the Government is approaching the whole issue. The negotiators will continue to push for changes to the DES because, as it stands, it is believed few practices would be able or willing to do it. There will be increased efforts to convince MPs and patients that Government plans are misguided and that attempts to micromanage practices from Westminster are a recipe for increased patient dissatisfaction.

Dr Laurence Buckman, Chairman of the BMA’s GPs Committee, outlines the BMA’s significant concerns about the Government’s proposed changes in a four minute BMA podcast and webcast that can be accessed via the links to the right of this page

• Read the BMA press release outlining GPC’s response to the Government’s contract changes:

• Read the BMA response to Alan Johnson’s letter to GPs on 4 February 2008

• Read a BMA News report about GPC’s analysis:

• BMA and LMC members: Login to lobby your MP about the future of general practice

Outline of options A and B (England)
The Government's proposals (Option A):

• £158 million of funding recycled from the 2007/08 Access and Choice and Booking DESs (in England) would be reinvested in extended opening as a DES including £2.80 per patient per annum for providing extended access
• 58.5 QOF points (38.5 from the holistic and organisation domains, plus 20 points from the patient experience domain) would be reallocated to support access arrangements
• Extended opening would be for 30 minutes per week per 1000 registered patients - this would need to be in blocks of 1.5 hours after 6.30pm or for one hour prior to 8.00am or on Saturday morning and would depend on agreement between the practice and the PCO reflecting local patients’ wishes. This would be provided through a nationally agreed Directed Enhanced Service (DES), and practice participation would be voluntary
• Part of the funding available for access (35p per patient) would be dependent on the results of access questions contained in the QOF patient survey. This would include targets for 24/48 hours access and booking
• There would be 1.5% uplift in the contract value, although it is unclear how this would be allocated and what additional work on top of the DES further practices would have to do to achieve this.

If the profession did not agree with Option A, the government has said that Option B would be imposed, details are as follows:

• Extended opening funded via £158m from the 2007/08 Access and Choice and Booking DESs but locally agreed arrangements
• There would be 135 points permanently removed from QOF including clinical areas such as influenza vaccination and management areas such as computer security. The overall impact would be a QOF with only 865 points instead of the current 1000.
• All lower QOF thresholds would be uniformly raised to 50%. The upper threshold would be raised to the national achieved average. In general, practices will lose money as the range gets narrower unless they are scoring above the higher threshold for that indicator
• There will be no QOF achievement payment until the end of the first quarter
• The funding, as described above, would be allocated to PCTs for them to agree local contracts for extended opening with any practices – including those newly set up private APMS practices. Experience has shown that it is likely that only a proportion of the funding would end up with any general practices if allocated to PCTs.

Scotland
GPs in Scotland have been presented with the same ‘UK offer’ (offer A) as in England although the Government has provided £9.5m additional new funding. SGPC has been involved in discussions with the Scottish Government on flexibilities around the implementation of this offer in Scotland and has received assurances from the Health Secretary that if the profession rejects ‘offer A’ then the government will negotiate with SGPC on an alternative offer in Scotland.

Read more detail on the Scottish offer

Northern Ireland
GPs in Northern Ireland won't have to offer extended opening hours. The BMA's NI General Practitioners Committee has received a formal contract offer from the Department of Health, Social Services & Public Safety which will be discussed with all GPs in Northern Ireland at a series of roadshows at the following venues:

• Southern LMC area – Tuesday 12 February – Canal Court Hotel, Newry
• Western LMC area – Monday 18 February – Mellon Country Hotel, Omagh
• Eastern LMC area – Wednesday 20 February – Stormont Hotel, Belfast
• Northern LMC area – Thursday 21 February – Dunadry Hotel, Antrim

Each event will commence with tea, coffee and biscuits on arrival at 7.00 pm with a start time of 7.30 pm