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Blog: 8am to 8pm care for £25?

16 October 2013

Exclusive Although Dr James Kingsland OBE thinks the government's offer of £100 per head to provide seven day care is generous, he thinks it can be done for a quarter of the price

Exclusive Although Dr James Kingsland OBE thinks the government's offer of £100 per head to provide seven day care is generous, he thinks it can be done for a quarter of the price
In these times of financial austerity it is heartening to find that general practice has been afforded an opening to bid for £50 million to improve their services for “hard working people”. The announcement, which could be regarded as more than a doubling to GP contract income levels, is possibly a once in a career time opportunity, and moreover provided without the need for any professional body negotiation. 
On 1 October this year, the government published its intention to invest at least £100 per head of population in pioneer sites who could demonstrate improved access to not just their surgery opening hours – 8am till 8pm, seven days a week – but to the range of services available and to different types of access using existing technology (email and Skype for example). 
My practice has recently described the concept of ‘the never full practice’. This has been delivered by a detailed understanding of demand management in general practice, which only people working in general practice really understand. Through a process of shaping the demand on the service and with some improved capacity through multidisciplinary team working, we now have a system where pre-bookable, same day, urgent or immediate appointments are all provided to the registered population. No one, during our current opening hours from Monday to Friday need use any other system for either scheduled or unscheduled care, which can safely and appropriately be provided within primary care. This is not unique within general practice, but certainly not standard.
We have been able to deliver this following a non-recurring investment from our clinical commissioning group (CCG) and have now been able to describe what the ‘primary care home’ could look like and its delivery of unrestricted care during weekdays. We also now know that to sustain this, we would need in the region of £15 per head of population recurring. This provides bespoke, personalised and responsive care to the registered list. 
We have also now calculated the resource required to extend this ‘never full practice’ concept across the weekend to provide both routine and urgent care through a 12 hour period. We are confident that this could be provided for £20 per head enabling 12 hour care across seven days a week to cost in the region of £35 per head of population annually in addition to the current GP contract. A small management fee to facilitate this working would also be required at £5 per head. 
This is probably a more sophisticated calculation than that used by the then NHS Commissioning Board (now NHS England) to determine that approximately £25 per head was required for management costs of CCGs and probably represents far greater value for the public purse, 
It is therefore most encouraging to hear that the government are offering two and a half times the necessary cost to deliver this service. 
While the intention is to explore different models of primary care delivery and pioneers often need pump priming, it does question whether we should more effectively invest in established best general practice to develop the care that the public deserve.
The health economics of the government’s offer remains unclear. However, to deliver the aspirations of extended hours with current contractual arrangements and care records, investment in single practices may be more cost efficient than a federated approach which may simply reproduce a variation of the GP co-op out-of-hours service.  

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