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GP finance - How to ... offer eight to eightsurgeries

There is plenty to consider when making a case for funding longer opening hours, writes Jennifer Taylor.

It seems to be widely accepted that patients want their GP practice to offer longer opening hours. The government has promised incentives for practices that offer longer opening hours, in the primary care White Paper, 'Our Health, Our Care, Our Say', but GPs are wondering whether the money offered will be sufficient to pay for the staff and the premises requirements this will entail.

Find out what your patients want

Find out what the patients at your particular practice want before you rush into anything. At which hours do they want to access the surgery? Where would they go if you decide not to provide this service? How likely is it that they will go elsewhere?

Once you know what your patients want, you can look at what you can do to meet their needs, and whether opening from 8am to 8pm is something that you can realistically offer.

Consider additional costs

Keeping the practice open for longer will mean incurring additional staffing and other costs. If you will be offering normal surgeries, you will need a doctor and a nurse; if you are a dispensing practice you will need additional dispensing staff.

Regardless of what services are being offered, there should always be at least one receptionist on duty. Don't forget the additional heating, lighting and electricity costs.

Make a business case

Construct a business case after finding out what your patients want, the likelihood of losing them to another practice, and how much it will cost to provide what they want.

Practices at risk of losing patients, if they do not open from 8am to 8pm, might find that it makes business sense to open the extra hours.

But if opening extra hours will cost more than keeping the patients who want such a service, it might be cheaper in the long run to lose the patients.

Kathie Applebee, management consultant at Practice Consultancy Services, says practices need to look at their costs and keep reviewing them.

'What does or does not make economic sense right now might be quite different in six months' time,' she says.

Consult staff

Identify the staff who are willing to do things differently and what they are prepared to do. If you want people to work at night, at weekends, or work longer hours, contracts for employment will have to be renegotiated. Staff might expect to be paid more for work during 'unsocial hours' and this will have to be discussed. If contracts cannot be renegotiated or staff do not want to change them, you will have to hire extra staff.

Construct a staff rota

Decide what services you will offer at what times, then construct a staff rota. 'The most important thing to remember when drawing up the rota is that you can't think about extending the clinicians' working hours because it's not safe,' says Ms Applebee.

But some GPs might be willing to drop a session during normal hours to take on one of the new surgeries.

Tell your patients

You will need to communicate the changes to patients if they are to take up the new service. Regular users can be contacted quickly by giving out information with repeat prescriptions. Posters can be put up in the surgery and you can put information on the practice website.

Set down some rules

Be careful how you define the services and sell them to patients. There is no point in having a commuter surgery if it is filled up with patients who could come during the day.

This surgery should be labelled 'commuter surgery' and have criteria for who is eligible to attend, and these should be well publicised.

CASE STUDY: THE GRANGE PARK PRACTICE

The Grange Park Practice in Leyton, east London, is open from 8am to 8pm, Monday to Friday, and from 9am to 1pm on Saturday. The extra hours began as a pilot funded by the SHA that ran from November 2004 to September 2005. During the pilot, the practice was open from 8am to 8pm, seven days a week.

'We learned that people didn't want to come out much on a Sunday,' says Hilary Powell, business manager at the practice. But patients did want to see a doctor at the weekend, so the practice opted for a Saturday-morning surgery. Despite efforts to limit the surgery to booked appointments, it is developing into an emergency service.

The idea was that if the practice gained enough extra patients, the service should fund itself. The practice's patient list is growing, but not quickly enough. The result has been that the service is costing the practice money.

Ms Powell says: 'If we want to continue it, we have to either boost our numbers by a large amount or we need some sort of local initiative, such as a local enhanced service.'

Dr Dinesh Kapoor, one of the GP partners, says patient feedback is positive, despite the Sunday opening being cut and the restrictions to the Saturday-morning service.

'They are happy we still offer the service, but there is more clinical triaging now because we have to prioritise our appointments system,' he says.

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