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How we approached the extended hours DES

Dr Jeremy Phipps describes his rural practice's extended hours scheme.

Dr Phipps' practice now provides early morning and Saturday surgeries (iStock)
Dr Phipps' practice now provides early morning and Saturday surgeries (iStock)

Like many practices we viewed the suggestion of providing extended hours with a degree of scepticism. It was already possible to book an appointment in the practice at any time between 8am and 6pm so there seemed little demand from our patients for such a service.

Interestingly many patients perceived the information about extended hours that was coming from the DH as a partial return to our previous practice-based out-of-hours service. The local out-of-hours service was not held in great esteem, being based eight miles from the practice, with a high number of patients being triaged by phone to A&E and the perception among many local residents that there was no GP service at night.

Key concerns

Belatedly we decided to provide an extended hours service, seeing it as a way of funding extra routine appointments for patients at a time when we were struggling with provision. The problems with the local out-of-hours service and of security in the building were two important factors in planning the service.

We are a large, 12-partner, part-dispensing practice operating from one main site with a smaller branch surgery. We worried that opening the practice beyond the normal times would lead to many patients asking to be seen as an emergency, particularly as the main practice is on a very visible site.

Building and personnel security were other factors. There was little that could be done to limit access within the building once a patient entered and we did not wish to employ extra security staff.

Early morning and Saturday surgeries

The main solution was to undertake early morning surgeries, starting at 7.30am, with pre-booked appointments for two doctors at the main site and one at the branch surgery. As some staff already started at both sites from 7.45am to prepare for the day, the extra staff costs were relatively small.

In addition we also provide a two-hour Saturday morning surgery with two doctors. This is undertaken at the branch surgery, which is safer: there is little possibility for any intruder to evade detection in this smaller environment. Also, by using the branch surgery there is less likelihood of extra patients attending and asking to be seen as an emergency.

Both sites have only one extra member of staff, a receptionist at the main site and a dispenser at the branch surgery. As well as keeping costs to a minimum it has improved the access for some patients to a dispensing service.

Patient response

In line with other practices, I suspect that patients attending these extended hours sessions are similar to those seen in usual surgeries. We have not seen a rush of working patients grateful to attend for their health problems and who were unable to attend at other times. 

There is still a degree of frustration among patients that other services are not available in the morning, in particular phlebotomy and community pharmacies. 

The longer day, now from 7.30am to 6.30pm, can be difficult and we still debate whether the extra income is worth it. But the alternative would be to lose this income source and face the extra cost of providing more appointments during the normal working day.

  • Dr Phipps is a GP in Lincolnshire

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