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Half day closing and extended hours

Section 4 Part 9 of the Primary Medical Services (DES) Directions 2017/2018 indicates that from October 2017 practices that regularly close for a half day, on a weekly basis, will not ordinarily qualify to sign up for the Extended Hours DES.  There may be exceptions to this – for example, where it is locally agreed for branch sites or small rural practices to close with appropriate cover remaining in place. But these exceptions will have to be agreed with NHS England first.

This is naturally causing concern to some practices, especially those that have historically closed for a couple of hours during lunch time or a half day a week for many years. Our understanding is that later this year the GPC will be publishing further guidance on this element of the contract following discussions with NHS England. However, we have not yet been given an indication of when this will be published.

Given that the change will not come into effect until October 2017 it does at least give practices time to review and consider alternatives and make any necessary arrangements to meet the new requirement.

Remember that the core hours (unless stated otherwise in your PMS or APMS contract) are 8.00am to 6.30pm Monday – Friday i.e. no lunchtime or half day closing. 

Although it is not a essential to have a doctor on site for all of this time, the Directions state that it is a requirement that: “Patients must be able to access essential services which meet the reasonable needs of patients during core hours from the contractor’s practice or from any person who is sub-contracted to provide such services to the contractor’s patients during core hours.”

Generally, this means that patients should be able to access the practice (or sub-contractor) to make/cancel appointments, request/collect prescriptions, register, bring in/collect paperwork etc. during the whole of the core hours period.  Therefore, cover by your local Out of Hours service is unlikely to be considered adequate by the commissioners in the future as it will not be able to offer these services to patients

With this in mind, we suggest that you plan ahead by:

• Reviewing your current opening times, and if you currently close during core hours, look at what staffing/service changes may be required to remain open between 8.00am – 6.30pm. Do not consider lone working for staff/doctors unless you have carefully reviewed/ risk assessed the health and safety aspects of this.
• Speaking with your PPG and/or wider patient base to ascertain their thoughts on whether you should either: continue to close (remember this still may not be a viable option) and not then undertake paid extended hours in the future or open throughout core hours and continue to undertake extended hours.
• Speak with your CCG and local LMC to ascertain their views and local guidance.

Our understanding is that practices may still be allowed to close on an occasional afternoon for staff training, protected learning time etc. and again you should seek guidance on this from your local CCG/LMC.

Links

The BMA has produced a FAQ sheet on the 2017/2018 GP contract changes which may be accessed here.

To access the full Primary Medical Services (Directed Enhanced Services) Directions 2017 document, click here.

Last updated : 26 Apr 2017

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