Promoting the interests, aspirations and welfare of general practitioners in North and South Essex

GMS Contract Negotiations 2008/09

Message From the Chief Executive

If 50% of practices provide the DES, there will be no Local Enhanced Service

DES
The DES is voluntary for practices.

The final detail of the DES is still not known.

Practices are not contractually obliged to provide the baseline audit information on extended hours currently being requested by PCTs and are advised to think carefully before doing so.

Low uptake of the DES by practices will make it extremely difficult for PCTs to hit their centrally imposed 50% target.

LES
Representatives of the LMCs and PCTs recently met to try and agree a more flexible, properly resourced LES as an alternative to the DES.

It was not possible to make any progress.  PCTs intend to await the uptake of the DES by practices.

The PCTs’ sole concern is to hit their 50% target.  PCTs claim to have no more money available to commission an improved service for patients – only £2.95 per patient!!

South Essex LMC has since decided that no further discussions on a LES should take place.  North Essex LMC is likely to take the same view.

If PCTs achieve 50% target, they need do no more!  This is as good as it gets!

COSTS
The LMCs have been working with a number of practices to try and establish the costs of providing an extended hours service.

The average cost detailed below includes GP time, admin support and overhead costs.  Nursing costs are available but have been excluded.

8 practices have provided information to the LMCs.

The list size of the practices ranges from 2,113 to 14,232.

The average hourly cost  is £183.00.
Average list size for the 8 practices is 8,047. (The average practice).

Under terms of the DES, this average practice would need to provide 4 extended hours.

Cost to the average practice 4 X £183.00 = £732.00 per week.

£732.00 X 52 weeks = £38,064.00

Using this example, the average practice of 8,047 patients would need to receive £4.73 per patient to cover costs.  NB This does not include nursing costs!!

The proposed DES payment, assuming that all £2.95 is payable for extended hours, would provide the average practice with £23,739.00 per annum – a shortfall of £14,325.00.

Points worth stressing:-
The DES is voluntary and practices are not contractually obliged to participate.

Await the final detail of the DES.

Don’t panic!  The PCTs have a target to meet – not practices.

Calculate your costs in providing extended opening hours.

Think carefully before agreeing to provide a service that does not cover your costs.

In most cases practices are able to undertake other work that will better enable them to make up the shortfall in income arising from the 2008/9 GMS/PMS contract changes.

If GPs don’t sign up to the DES, PCTs will have to consider a LES.

If practices have any further questions or concerns about the proposed extended hours arrangements, then please contact the LMC office for advice.

Dr Brian Balmer
Chief Executive