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7-Day Working 

Dr Clay explores General Practice working 7 days.

The NHS already offers a 24 hours-a-day, seven day-a-week primary care service.

However, it doesn’t offer a 12/7 routine care service. The concern is that this lack of routine care outside of the current 52.5 hours-per-week GP contract is driving up A&E attendance and thus hospital admissions.

 It is true that attendance at A&E has a direct correlation with hospital admission but is there an inverse correlation between GP opening hours and A&E attendance?

The government thinks so but A&E attendance peaks in the hours that correlate to standard GP opening hours in the week, with the peak demand being on Mondays.

Peak attendance time in A&E at weekends is also between 8am and 8pm, hence the reasoning that routine 7 day opening of GP surgeries between 8am and 8pm would reduce A&E attendance.

The question is; if it doesn’t reduce demand in the week why would it at the weekend?

We know that patients of practices that offer a Doctor First-type access system have a 20% lower A&E attendance rate, even if they do not offer extended hours of opening, compared to practices offering a standard way of working.

The key difference is that Doctor First–type practices deal with true patient demand whereas practices offering traditional 10-minute appointments manage to satisfy only around 75% of that level of demand.

The answer, therefore, is to manage true demand.

Would patients use a routine Saturday and Sunday GP service? The answer is ‘yes’, but anecdotally it is often by people who could attend in the week. In addition, patients generally have better things to do with their weekends and evenings (as shown by the rise in A&E attendance on Mondays).

To cope with this additional opening with an understaffed workforce fewer sessions would need to be provided in the current standard working week. That would inevitably mean that patients would be just as unlikely to see their own GP as they are now, which would defeat the object of the Government promise that patients would have increased access to their own GP!

There has been no suggestion that the extended GP service would replace the out of hours service and that begs the question of why we would benefit from paying for an extended hours service twice?

SO what might be lost? With the 2004 GP contract perhaps the single most important factor in improving patient safety has been the abolition of an individual GP’s 24-hour responsibility for patient care. 

That guaranteed time-off has allowed doctors to recharge their batteries and so be in a far better situation to give of their all in the day.

Having said that, there is no new money to pay for these additional hours. Some money has been recycled from GP contracts to pay for additional hours and so many GPs may decide that they want to offer a seven day service to try to claw back some of that lost income.

How can the practice be set-up to most efficiently offer the service? We know that Doctor First soaks up the weekly demand and so demand is reduced in the evenings and weekends.

We will see if patients choose to use their weekends to see a GP for routine problems and Doctor First practices such as Salford Health Matters will lead the way in finding out what effect weekend opening will have on their weekly workload and what the true demand for weekend appointments is.

It will then be for the Government to decide whether the duplicated additional cost is the best use of those scarce NHS resources.


Dr Stephen Clay

GP and Clinical Director for Productive Primary Care Ltd

Thursday, September 24, 2015 11:41:00 AM

Spring in our step... 

April 2013

Dear Colleagues

I hope you are enjoying the new web site, we are certainly receiving positive feedback on the design and content. We plan to place regular bulletins to keep you up to date with our work and what is happening nationally. 

There are many new features on our website which include:

A big thank you goes to Dr Alison Graham who kindly shared their story of how Doctor First had improved the access and quality of service they now offer to patients. We are also pleased to announce that following the succcesful implementation of the system Alison has agreed to join our team and now trains other clinicians implementing Doctor First. 


The forum is a new development we wanted to give you access to which will allow you to connect with other like-minded practices and share experiences or ask questions to a wider audience. Please register once you have started work with us and we ask you use it as a first line of enquiry for any questions you may have. Bouncing ideas and suggestions off of other colleagues can often be rewarding and reassuring. There is also a section for clincians to post clincial queries they may have about using the system. 

If like Yaxley Group Practice you want to share your story there is a section under the forum to place this. We appreciate any contributions to this section.

On Line Booking DES

As you will be aware DH are wanting to improve digital access to services for patients. The 2013/14 DES for on-line booking will need particiapting practices to offer patients the ability to book appointments online. In its current form this would be timed 10 minute face-to-face slots but this would not work in a Doctor First system where patients discuss with a clincian on the telphone before deciding if they need a face-to-face appointment. 

Please check with your clinical system provider to see if you can offer un timed slots for patients to book on line. We are communicating directly with developers at EMIS and will post a reply as soon as we have one.

The payment for participating GP practices will comprise three components, each representing a third of the investment available for this enhanced service in the 2013/14 financial year: 

Component 1: A single payment of £0.14 per registered patient, which represents a payment of £985 for an average-sized GP practice (registered population 6,911) based on satisfactory evidence of enabling and utilisation of online booking; and, 

Component 2: A further single payment of £0.14 per registered patient, which represents a payment of £985 for an average-sized GP practice (registered population 6,911) based on satisfactory evidence of enabling and utilisation of online repeat prescribing; and, 

Component 3: A flat rate payment of £985 to each GP practice based on satisfactory evidence of a proportion of registered patients being issued with passwords for accessing services online.


We are still very busy at the moment working across the UK, mainly helping practices with demand management and our team of associates has recently grown to reflect this. If you want to know more about our team please click here.

We are working with over 50 practices currently mostly one-to-one but our workshops organissed at CCG level are also proving very popular in helping practices implement the Doctor First system. 

Practices recently moved over to Doctor First have reported positive experiences and a decrease in patient complaints. There are of course teething problems as with any new system and our follow-up support will help smooth these. If you feel you need further support outside of any commissioned work with regards to development and training please get in touch to see what we can offer you. 

The most common feedback from practices is that they are 'surprised' at the level of demand by patients that Doctor First places on practices. In truth that level of demand has always existed but has previously been 'blocked' from the view of doctors by the system they operated. When practices understand this and accept the values and benefits of the system it is realised that Doctor First is the most benficial system for patients and practices. 

If doctors report back that they have spoken to over 65 or more patients in any one day we can almost certainly predict that they will have had doctor sessions missing for that day. The way we design the system then that amount of patients per day should not be normal for any doctor. It mainly happens when a doctor or two is away on leave and no backfill has been put in place. 

Many practices are now seeing that demand is predictable and can ascertain how many patients per day will contact them and this prior knowledge can give practices greater control in managing demand.

Our latest patient feedback report was from The Endeavour Practice in Teeside who recently moved to Doctor First. The feedback is extremely positive and 88% reported it as an improvement on their previous appointment system. Well done to Steve Donlan and his team at the practice.



Monday, April 22, 2013 11:06:00 AM Categories: News

New website launch 

We're happy to announce that today sees the launch of our brand new website, company branding and complete printed literature inc. brochures and exhibition materials.

Working in conjunction with Barnsley based design & marketing agency DMSQD, we have developed this over the last few months as we look to continue our pristine service to the primary care sector.

Wednesday, February 20, 2013 8:41:00 PM Categories: News

“As a result of the work done with Productive Primary Care (PPC), we have changed the way we work and improved access for patients by 200%”
Mr Chris Thompson, Stag Medical Practice, Rotherham

0800 6990184 Crafted by DMSQD