Demand for longer surgery opening hours unjustified, say GP managers
More than 70% of practice managers do not believe there is a genuine need for extending surgery opening hours, and nine in 10 think funding allocated for this should go to other areas of patient care, a Management in Practice survey has revealed.
In addition, seven in 10 managers say they have concerns over the safety of staff members working later in the evenings.
More than 500 practice managers completed the MiP survey on the introduction of longer opening hours for GP surgeries.
When asked whether they believed a demand for extended hours was reasonable, 73% of practice managers said they thought it was a "patient 'want' rather than 'need'", with only 27% saying they could sympathise with those who struggle to fit a GP appointment around a busy schedule.
One survey respondent said: "After 15 years in practice management, this is perhaps the most naked attempt by the Department of Health (DH) to assert political control over GPs, and the justification in terms of patient demand is wafer thin".
Responding to these results, a DH spokesperson told Management in Practice: "We know that where surgeries already offer more convenient appointment times they are popular with the public and GPs".
Yet 89% of practice managers said there were more important areas of enhancing patient care where they would prefer to see funding go. The most popular alternatives included addressing the needs of the elderly and those with chronic illnesses, developing the practice's premises and enhancing community support services.
Security was also a significant concern among practice managers. Seventy-one percent said they concerns over the safety of their staff working the longer hours.
"In the winter, with open access to the front doors, who will walk in off the streets?" said one respondent. Another said: "We are unhappy about a lone receptionist in one part of the building and a lone GP in another".
The survey suggests the latter scenario will be commonplace: just under half (43%) of managers said a single receptionist would be the only non-clinical member of staff present during the later hours, while 60% said just one GP would be working at these times.
In response to these results, Dr Laurence Buckman, Chairman of the British Medical Association's (BMA) General Practitioners Committee (GPC), said: "I am very worried by the prospect of so many practices operating with little safety back-up. Nobody should have to work like this."
The Management in Practice survey results mirror those of GPs in the recent GPC survey on extended hours. The vast majority (89%) of practice managers said the government's method of negotiation over introducing extended surgery hours was "unacceptable". This compares with 98% of respondents to the GPC survey who said it was "not acceptable".
In addition, 91% of practice managers preferred the first of two contractual options for 2008/09 that were presented to GPs earlier this year. This compares with 92% of GPs in the GPC poll.
Responding to these results, Dr Michael Dixon, Chairman of the NHS Alliance, said: "I think it is absolutely fascinating that practice managers do more or less mirror the BMA GP survey results. It's good to see that at the frontline, at least, clinicians and managers are in tandem!"
Stuart Gidden, Supervising Editor of Management in Practice, said: "The results suggest that it is not the requirement to open longer that practice managers object to, but the introduction of national targets for this – which do not take into account the differing needs of local populations – and the fact that they were not consulted on this change.
"In our survey, 60% of managers said that, in principle, they would be happy to extend their surgery's opening hours if sufficient funding was there."
As one respondent to the survey said: "If the government had approached this subject in a more friendly and open manner, and practice managers had been included in the discussions, I believe you would have seen a totally different outcome and less opposition to the proposals."
To read the full survey report, see:
Time management – the MiP opening hours survey results
For more on MiP surveys, see:
www.managementinpractice.com/surveys
Your comments: (Terms and conditions apply)
"The problem is that practice managers often base their opinions on the views of those they see at their practices. These are on the whole patients with chronic illnesses who have no problem with the need to book in advance. Those who are in work have long ago given up on their GP and either self-treat or use walk-in centres or A&E. In Australia, where a system operates whereby GPs are paid by the number of patients registered with them, evening appointment sessions are routine" – Alan Turgwe, Mansfield
"Unfortunately we will never be able to meet the demands of all patients. There will still probably be lorry drivers and other workers that need appointments outside of these extended hours. How far do we go to meet demands?" – Tina Taylor, Staffordshire
"I agree with other practice managers as demand is high with some locality. Practices are working hard to achieve targets and can't take more pressures" – Chhaya Shah, Middlesex
"Not the least bit surprised. I think that we all recognise the need for a bit of flexibility to assist those in fulltime employment but it is the prescriptive way in which the government has imposed this upon us. We will probably extend our appointments from 8am to 6.15pm which should enable the vast majority of patients to make an appointment. Those who can't have the option of the PCT Access Centre" – Allan Stewart, Wirral
"I'm not at all surprised. They should have only put the onus to provide extended hours on those practices where a real need for them was shown" – Jean Kennett, Isle of Wight