Out of Hours

25 Oct 2015

Out of Hours GPs Will Need to Adapt to New GP Contract

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Out of hours GP Tarun Gupta analyses the new GP contract and how this will affect out of hours (OOH) GPs.

Most of us have been engaged with the ongoing debate around the junior doctor contract that is dominating our Facebook newsfeed, with friends or loved ones directly involved with planned protests and making appearances on TV, Twitter and other forms of printed or social media.

The response from Mr Hunt  indicates that there is some recognition that Sunday is regarded as ‘unsocial’, with what constitutes ‘unsocial’ for Saturday still up for negotiation. During the newly proposed ‘normal’ working hours, we will see many more junior doctors on the wards.

In parallel - although with much less furore or fanfare - we have seen the discussions around the new ‘voluntary’ GP contract, which looks at extending open hours for GPs during weekdays and also at weekend opening, via federations. Nonetheless, it is evident that nights (however defined - but 10pm to 7am is a reasonable start) and at least some portion of the weekend, will remain as core OOH work for GPs.

With GPs having to work longer hours in their own surgeries, will this mitigate the need for OOH GPs? Where will the GPs to provide extended hours come from?

In a sense, the same GPs who work OOH will end up working for regular surgeries to enable them to offer this service as many regular GPs are already working flat out and have other family commitments that will make it difficult for them to provide extended hours.

There is also the change in emphasis from ‘OOH’ care and ‘routine’ care, with the government making it clear that the new arrangements are to be built around patient preference and ease of access, so OOH GPs may find themselves on Sunday prescribing creams for acne and making referrals to the MSK clinic rather than dealing with what is currently regarded as ‘OOH’ work.

While most OOH GPs are also working in regular surgeries, there will be implications for the small proportion who only deliver OOH services including re-engaging with QOF, chronic disease management and local referral protocols.

With OOH GPs making entry in SystmOne for instance and having access to certain portions of the patient’s regular records, the burden to manage the ‘OOH’ consult will become greater. This has the knock-on effect of hopefully even reducing indemnity costs and should act to reduce risk as more information becomes available.

There are obvious challenges around funding and implementation.  For many GPs - as well as junior doctors - the reality of trying to balance a family life with current patterns of working hours is already tricky.

The new proposals risk taking GPs away from providing weekday care. They also assume that the support staff needed to run a practice, such as receptionists, nurses and the admin team, also embrace the proposals.  Will they accept these are normal working hours and if not, how will GPs fund these new costs with the financial constraints they are already facing?

There is, of course, a whole other debate as to why a patient with acne needs seeing on Sunday afternoon, but that is for another time…

Read Tarun's other articles on GP OOH: what to look for in an OOH provider and reasons to work as an OOH GP.

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