Our practice in Kingston, Surrey took a corporate decision to extend opening hours using our existing resources. The surgery opens 12 hours a day until 8pm, Mondays to Thursdays. On Fridays we close at 6pm and on Saturdays, patients are seen from 9am until 11.30am. This is how it worked for us.
Decide the ground rules
Be clear that as a practice you wish to extend opening hours. Arrange meetings with staff to ensure they understand that this new way of working may well make their life easier. Make sure all staff know that no one will be expected to work a 12-hour shift, or unless they want to, longer hours. If taking on extra staff to cope with a bigger list, consider advertising for someone prepared to work in the evening. One of our GP partners, Dr Bimal Raja, does a lot of late sessions because this suits him.
Respond to patients' needs
We increased access because some patients asked for evening and Saturday appointments, and because for workers not allowed time off in the daytime to see the doctor continuity of care is meaningless if they cannot get to see a GP at all.
You can service a larger list size without moving premises by seeing patients 12 hours a day instead of the usual six hours. Acting together to meet patients' needs will enable you to reorganise.
Plan your new opening hours
On weekdays, consider professionals starting two hours later in the morning to make up for finishing later. Deal with on-call and home visits issues. It is difficult to be on call and have an evening surgery - and a late starter cannot be on call early in the day. Home visits are also likely to require review at some point. Schedule regular meetings because you may see each other less often.
Split the day into three or four sessions to accommodate staggered surgeries. Start small with perhaps one or two late finishes or early starts because it takes a while for patients to adjust. Late surgeries can play havoc with cleaning arrangements, so involve cleaning staff in the discussions.
Try out the system
Start with one doctor and a receptionist and only have manageable, booked clinics. Put phones over to the out-of-hours service or pass home visit requests to it. Most people want to see a GP during daylight hours, so do not shift more than a few appointments to the evening. We found that few patients want routine appointments after 8pm. You can slot in nurses, other GPs and walk-in sessions when expanding extended hours to more days.
Calculate the cost
Opening until 8pm for four nights a week means only six extra hours a week if the surgery used to close at 6.30pm. The pay for some hours may be at a premium rate, but some staff may want to work later shifts. Move existing surgery commitments rather than employing extra staff. Add up the premium payable to professional staff (on top of normal hourly pay) and include an element of expenses for infrastructure (heat, light and so on).
If surgeries are moved or opening hours changed when new staff are taken on, make early and late starts part of their job terms to keep down extra costs. The basic expense will be a receptionist at around £10 per hour plus, say, a 25 per cent premium per hour for late/early working. Your annual costs may be as little as £6,000. We calculated our costs at £6,032.
Inform patients and implement
Patient will be hugely appreciative. Extended access may attract new residents who require later primary care contact. Let your primary care organisation know but do not ask permission. It could insist your practice offers the same hours as others as has happened in one area. Unless enhanced service monies are freed up, it will not pay you extra.
Review the arrangements
The out-of-hours service may become confused so inform the service in writing of the changes. Security arrangements may need reviewing and other, initially reluctant team members may wish to join in. Survey your patients about extended hours.
Churchill Medical Centre
Monday to Thursday: 8am-8pm.
Saturday: 9am-10.30am, emergency surgery.
9am-11.30am, pre-booked patients.
- Second-wave PMS practice with 10 doctors.
- RCGP Quality Practice Award holder.
- PMS has allowed us to be flexible and innovative with our use of resources and to respond to our patients' changing needs.
- For more about the practice, visit www.churchillmedicalcentre.com.