Direct Enhanced Service (Des)

GP Extended Hours Access DES

DIRECT ENHANCED SERVICE (DES)

FOR

GP EXTENDED HOURS ACCESS

1 April 2011 - March 2012

NHS Blackburn with Darwen Teaching Care Trust Plus (CTP)

Document Control

Title of Document / GP Extended Hours Access Scheme Directed Enhanced Service (DES)
Author’s Name / Jillian Wild
Author’s Job Title / Head of Service Transformation
Dept/ Service / Service Transformation
Doc. Status / FINAL
Based on / The Primary Medical Services (Directed Enhanced Services) (England) Directions 2011 DH
GP Extended Hours Access Scheme Directed Enhanced Service 1 April 2011 to 31 March 2012 DH Guidance
Financial Entitlements (Amendment) (No. 4) Directions 2008
Signed Off By / Jillian Wild
Original Publication Date / April 2011
Next Review Date / March 2012. This enhanced service will be reviewed for 2012/13 but will not automatically renew unless nationally directed.
Distribution / General Practitioners in Blackburn with Darwen

1.0Service Description

GP Extended Hours Access Scheme Directed Enhanced Service (DES)

2.0Introduction

The intended outcome of the GP Extended Hours Access Scheme DES is an increase in patients’ access to primary medical services, through face to face appointments with a GP at times outside practices’ current core contracted hours, in line with patients’ expressed needs andwishes.

Agreement has been reached with the BMA’s General Practitioners Committee that, for a further year from 1April 2011, GP practices will continue to provide extended hours but under a more flexible Extended Hours Access Scheme. The DES will provide greater flexibilities during extended opening hours as below:

• Concurrent working will be allowed;
• Patients will be able to see any health care professional[1] not just GPs;
• Appointments can be made for urgent as well as routine care:
• The minimum period of any one period of extended opening is reduced from 90 to 30 minutes; and
• The arrangements will not be monitored centrally.

3.0Background

In order to support the implementation of the NHS Next Stage ReviewInterim report, Our NHS Our Future, October 2007, the CTPwishes to commission greater flexibility in GP opening hours to ensure patients have a greater choice of when to see a GP, by extending hours into the evenings, mornings or weekends.

4.0Application process

Practices that wish to participate in the DES must submit a proposal to the PCT by 30 June 2011 using the template supplied in Appendix A. The PCT will review the proposal and respond to the practice within 28 days of the application. Where the PCT is not minded to approve the proposal discussions will be held with the Practice to endeavour to reach agreement.

5.0 Service Outline

5.1 This DES contains advice for the service specification for the GP Extended Hours Access Scheme agreement between practices and the CTP. This service specification will supersede all previous correspondence from the CTP.

5.2 The CTP will continue to commission the Out of Hours (OoH) Service whereby the current provision of service will remain unchanged. Urgent problems and visits will continue to be undertaken by the current OoH Service, who will also continue to have responsibility for the telephone system.

5.3 Requirements under the 2011 DES Directions

5.3.1The 2011 DES Directions set the minimum requirements which must form part of the arrangements. All the requirements below form part of the contractual terms between the CTP and the GP practice. An existing contract must be varied accordingly so that the requirements are made conditions and form part of the contract.

5.3.2 Arrangements between the practice and the CTP for the provision of extended hours access under the 2011 DES must be made in writing

5.3.3 The arrangements entered into under the 2011 DES Directions must include a written obligation by the GP practice to implement the agreed arrangements. The agreement must also set out the details of the arrangements for extended hours access in order to enable patients to attend face to face appointments with any health care professional outside of core times. The arrangements must include the following provisions:

(i) the clinical session(s) are provided at the GP practice’s premises outside of core contracted hours. For GMS practices, core hours are from 8:00am to 6:30pm, Monday to Friday, except Good Friday, Christmas Day or bank holidays. For some PMS (and APMS) practices, core hours may already include opening at times outside these hours, and CTPs should treat the hours set out in such individual contracts as the core hours for these practices.

(ii) these clinical sessions are held on a regular basis each week from the GP practice’s premises. It is recommended that these are held at times that best match patients’ preferences for extended hours access at that practice, based on the most recent GP Patient Survey results, and/or local survey information, to decide when (and where in the case of practices with branch surgeries) to open.

(iii) these clinical sessions must be in addition to those provided within core hours. For example, a GP practice cannot provide sessions on a Saturday but then cut sessions on Wednesday afternoon within in-hours periods;

(iv) the amount of the extended hours access is linked to a GP practice’s patient list size (or a practice’s registered population - CRP). The minimum required extra opening for each practice is based on an additional 30 minutes per 1,000 registered patients, using the following formula:

A practice’s CRP ÷ 1000 x 30 = Additional minutes – convert to hours and minutes and round, either up or down, to the nearest quarter hour.

NB. CRP will be determined as at the start of the first quarter during which extended opening begins for individual practices. CRPs will be recalculated for this purpose (and for the purposes of payments – see below at Paragraphs 28 to 31) at the beginning for the 2010-11 financial year. The rules for this are set out in Section 7GB of the SFE Directions.

(v) these clinical sessions must be for continuous periods of at least 30 minutes.

5.3.4 The GP practice must co-operate with its CTP in reviewing the arrangements to establish whether the pattern of additional hours is meeting the requirements of its patients. For example, to establish whether a practice is still meeting patients’ needs, regard may be given to the results of the most recent patient surveys. Both the CTP and the practice should ensure that they fully understand how demand from patients might change at times over the course of the agreement – e.g. a practice might wish to alter its extended opening hours following results from a local patient survey and/or discussions with its Patient Reference Group where it is participating in the Patient Participation Directed Enhanced Service.

5.3.5 Where a GP practice provides an out of hours service, it must not limit access to any of these clinical sessions to those patients it would have been obliged to see anyway under the out of hours arrangements. In general, this should be a matter for the practice to manage and communicate to its patients

5.3.6 The arrangements entered into under the 2011 DES Directions must set out the requirements for a GP practice to provide to its CTP information that is reasonably necessary for the running of the arrangements. In agreeing these requirements, both parties may wish to have regard to the principles in the Code of Practice on Confidentiality and Disclosure of Information – see the link below:

5.3.7 The practice agrees to promote and publicise availability of additional sessions, as a minimum on the NHS Choices website, on a "waiting room poster" and in the practice leaflet. The CTP will publicise extended opening to local populations and help patients identify which practices are offering appointments at given times. This will be monitored on an ongoing basis.

5.3.8 Practices will not use extended hours to deliver non- NHS work.

6.0Service Monitoring and Evaluation

6.1Practices will agree to provide evidence of the work undertaken as part of this agreement and agree to submit quarterly data to the CTP by the 15th of the following month retrospectively. Practices will ensure that there will be no reduction in the overall availability of GP consultations and clinical care during core hours. The DES will not be commissioned where practices do not o provide baseline information in terms of current working hours/clinical session times (Appendix 1). Full co-operation is required from practices in terms of providing information to ensure that implementation can be monitored and services maintained. This information will enable CTP to collate quarterly information for the CTP regarding: Number of GP appointments offered (Appendix 2) per 1000 patients (including face to face, telephone and turn up and wait consultations). The quarterly data will be submitted by the 15th of the following month.

6.2Practices are required to submit a copy of their practice leaflet within the first two quarters of 2011/12.

6.3 The CTP reserves the right to arrange a Post Payment Verification Audit.

7.0Payment Schedule

7.1 Payments to the GP practice in respect of services provided under the 2011 DES will normally be made by the CTP quarterly in arrears in accordance with Section 7GB of the SFE (as amended).A practice offering extended hours under arrangements will be paid £1.90 per registered patient (CRP) . Payments will be made pro-rata where the arrangement does not cover a full quarter

7.2. The 2011 DES Is a new scheme and from April 2011 entitlement for payments will generally begin on the start date for the extended hours specified in the new agreement between the CTP and GP practice under the new arrangements. The CTP will pay retrospectively where a practice continued its extended hour’s services from the 2010/11 DES/LES. Any such payment will be at the 2011/12 rate. This payment will continue until such time as the PCT and the Practice have agreed new arrangements for 2011/12. In the event that the PCT and the Practice cannot reach agreement for 2011/12 the PCT may give four weeks’ notice on the continued payments.

8.0Duration of Contract

1 April 2011 to 31 March 2012. This enhanced service will be reviewed for 2012/13 but will not automatically renew unless nationally directed.

9.0 Provision for Disruption of Service

Practices should maintain agreed extension of services by providing sickness and leave cover or by providing sessions on alternative days. Practices should ensure that their patients are aware of any cancellation of extended hour’s services and these should be discussed and agreed in advance with the CTP (e.g. minimum 4 weeks in advance), where possible.

10.0Termination of Contract

Either party will be entitled to terminate this agreement by giving three months notice in writing.

The CTP reserves the right to invoke a remedial notice in accordance with the procedure laid out in the GMS Contract if it believes that a doctor/practice carrying out this service is not complying with the terms of the contract.

11.0Dispute Resolution

Both parties agree to abide by the terms of this agreement except where in exceptional and unforeseen circumstances it is no longer practicable for one or other of the parties to comply. Under such circumstances, both parties shall meet to resolve the situation. Where agreement cannot be reached an external arbitrator shall be appointed. If both parties cannot agree following arbitration, the agreement will be mutually terminated.

12.0Points of Contact

Jillian Wild – Head of Service Transformation Tel – 01254 282064

12.APPLICATION PACK

Practices that wish to participate in the DES must submit a proposal to the PCT by 30 June 2011 using the template supplied in Appendix 1. The PCT will review the proposal and respond to the practice within 28 days of the application. Where the PCT is not minded to approve the proposal discussions will be held with the Practice to endeavour to reach agreement.

12.1 Practice & CTP Signature of Service

SIGNATURES

We declare that:

• We are fully registered medical practitioners, included in the Medical Register
• The information provided in each section of this form and supplementary sheets, as applicable, is true and complete
• The practice is compliant with the terms this Enhanced Service for

If our application is approved, we agree:-

• To be bound by the Terms of Service/new GMS Contract
• To notify the CTP within 7 days of any material changes to the information which is provided in this application
• To inform the CTPof any changes of permanent addresses

This document constitutes the agreement between the Provider and the CTP in regards to this Enhanced Service.

Senior Partner Name
Signature

Date:

Practice Stamp:

Name of Primary Care Commissioner / Jillian Wild
Signature

13.Appendices

Appendix 1

Application to provide additional clinical session(s)
under the Extended Hours DES 2011/12

Please complete the fields below to provide the context for the extended hour’s proposal

Practice name
Practice contact for this DES
Phone number and email address of practice contact
Practice list size at 31 March 2011
Does the practice routinely close during any part of core working hours?
If yes, please give days and times

Latest GP patient survey results

can be obtained from

% patients able to see a doctor fairly quickly
% patients satisfied with opening hours
% patients who want surgery to open at additional times
% patients who want surgery to open before 8am
% patients who want surgery to open at lunchtime
% patients who want surgery to open after 6.30pm
% patients who want surgery to open on a Saturday
% patients who want surgery to open on a Sunday
Description of other surveys and patient preferences on opening hours

Practice proposal

For each session please complete the table below

Day of session
Start time of session
End time of session
Location of session if practice has more than one site
Healthcare professional(s) available for the session
Number of routine pre-bookable appointments split by professional
Number of urgent appointments split by professional
Day of session
Start time of session
End time of session
Location of session if practice has more than one site
Healthcare professional(s) available for the session
Number of routine pre-bookable appointments split by professional
Number of urgent appointments split by professional
Day of session
Start time of session
End time of session
Location of session if practice has more than one site
Healthcare professional(s) available for the session
Number of routine pre-bookable appointments split by professional
Number of urgent appointments split by professional
Reasoning for proposing the additional clinical session(s)
How will patients be informed of the additional clinical session(s)?

Please return this completed form to: Mrs Susan Dunnicliff, NHS Blackburn with Darwen, Guide Business Centre, School Lane, Blackburn BB1 2QH

Appendix 2

Quarterly Audit Form for Extended Hours DES 2011/12

Practice name
Practice contact completing this form
Phone number and email address of practice contact
Quarter
Practice list size

For each session please complete one column of the table below

Day and start/end times of additional session
Healthcare professional(s) offering appointments in session
Number of appointments offered during Quarter for session
Spilt of urgent to routine appointments in session
Number of appointments used during Quarter for session
Number of DNA’s during Quarter for session
How have patients been informed of the additional clinical session(s)?

Signed on behalf of the practice: ______

Please return this completed form to: Mrs Susan Dunnicliff, NHS Blackburn with Darwen, Guide Business Centre, School Lane, Blackburn BB1 2QH.

DES Extended Hours 2010/11 Version 1.Page 1 of 11

[1]This is defined as any member of a professional regulated by a body mentioned in Section 25(3) of the National Health Service Reform Health Care Professions Act 2002. Please note that this does not include health care assistants.