General practice is changing with more surgeries being run by private companies and the income of a practice being more closely related to the amount of work done (measured by various criteria of variable validity and relevance) and the number of patients on the list; and less related to the number of doctors working for the practice. The idea of evening and weekend surgeries is potentially workable.
My guess is that
1. there will probably be pressure put on PCOs to provide evening and weekend surgeries and they will offer some kind of financial incentive to GPs to do them. I would guess that this would be funded either by a national redistribution of Quality Outcomes Framework points to include points for Out of Hours cover; by a reduction in the emergency GPOOH cover needed if (particularly) weekend surgeries were provided; or by removing the Minimum Practice Income Guarantee.
2. At the same time, practices may reckon that by offering evening and weekend surgeries they can be more attractive to patients and increase their list size (and income). This increased income may work out as being more or less than the cost of running these surgeries.
3. Staffing these surgeries is likely to become easier- there is an increase in the number of vocationally trained doctors but since the new contract there has been a marked decrease in the number of jobs on offer, so I'd expect to see an increase in the number of jobs for salaried GPs including a bit of out of hours work.
4. Staffing may be by nurses, physios, ECPs etc. rather than doctors, but because general practices tend to be relatively small scale affairs and run by people whose main work is as a clinician and whose income fluctuates depending on how the practice is doing, I'd think they'd be in a better position and have a better incentive to keep a closer eye on the cost effectiveness and quality of non medical practitioners than hospitals do. The other possibility is using doctors who are not vocationally trained, again depending on quality and cost effectiveness.
> --> First, you must give him credit for such an original
> idea. No, not the
> idea of having GPs cover their patients out of hours - we had
> that for
> decades. The original idea is GETTIN RID of that arrangement
> so that, 2
> years later, you can claim credit for "inventing" it.
I don't think he's looking at a return to GPs covering emergencies in their own patients out of hours, but having elective surgeries out of hours, which is a new idea and probably more sensible, particularly if the IT can get sorted out to allow direct booking from A and E to GP meaning that patients who could wait for a next day GP appointment don't come through A and E.
Matt Dunn
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