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1 NHS Circular: PCA(M)(2012)5 Health and Social Care Integration Directorate Primary Care Division abcdefghijklmnopqrstu Dear Colleague REVISED DIRECTED ENHANCED SERVICE EXTENDED HOURS ACCESS FOR GP PRACTICES Introduction 1. This circular provides guidance on a revised Extended Hours Access Directed Enhanced Service (DES) for GP practices. The DES Directions setting out the legal obligation on Health Boards were issued under cover of circular PCA(M)(2012) 4 and come into force on 1 April This guidance replaces guidance issued for both the previous DES covering extended hours access for GP practices and the nursing extended hours DES. This DES will start on 1 April 2012 and will run on a year on year basis until further notice. 2. This circular also gives Directions to Health Boards on behalf of Scottish Ministers detailing the payment arrangements, Annex A, which must be made under the DES. 3. The DES has been agreed with the Scottish General Practitioners Committee (SGPC). 4. The detailed guidance for the DES is attached, 5 April 2012 Addresses For Action Chief Executives NHS Boards Director of Practitioner Services Division, NHS National Services Scotland PC Leads For Information GP Practices Enquiries to: Frank McGregor St Andrew s House EDINBURGH EH1 3DG Tel: Fax: Frank.McGregor@scotland.gsi.gov.uk Action 5. NHS Boards are required to bring this Circular and the attached guidance to the attention of GP practices in their area and their Local Medical Committee, and are required to action the Directions covering payment arrangements. Yours sincerely Frank Strang Deputy Director, Primary Care Division St Andrew s House, Regent Road, Edinburgh EH1 3DG abcde abc a

2 Extended Hours Access for GP practices Directed Enhanced Service Guidance Purpose This guidance summarises the arrangements for GP practices providing the extended hours access for GP practices Directed Enhanced Service for Scotland. Legal requirements Under the Primary Medical Services (Directed Enhanced Services) (Scotland) Directions 2012 ( DES Directions 2012 ), each Health Board must establish and operate an Extended Hours Access Scheme, and as part of that scheme, must offer to enter into arrangements with primary medical services contractors in its area. Detailed Guidance In summary, the DES Directions 2012 specify that the plans setting out the Extended Hours Access Scheme arrangements must provide for the following: 1. GP practices undertaking this DES will be required to provide a minimum of an additional 30 minutes of GP or other healthcare professional consultation time per 1,000 registered patients per week. The amount of time to be provided is calculated pro rata and rounded up to the nearest one quarter of an hour. Worked examples on calculating additional time are shown at Annex B. 2. There must be no diminution in the current core hours level of service (including access to GPs or other healthcare professionals), as a result of the practice providing extended opening hours. The extended hours sessions are generally to be provided outside of core contracted hours. However, where a contractor offers appointments to patients in the first or last 30 minutes of core hours, this may count towards the additional minutes required, provided that the contractor also provides 30 minutes additional consultation time directly prior to or after (as the case may be) the appointments offered within core hours. 3. The additional sessions are to be provided on a consistent basis, for example, at the same time each week, if appropriate and reasonably practicable. The times of these sessions should take into consideration any appropriate information on patient preference. 4. The practice must publicise their extended hours arrangements to patients. 5. Consultation time must be provided for pre-booked appointments as well as for urgent and routine care.

3 Flexibilities and Exclusions Smaller GP Practices For smaller GP practices with relatively low list sizes it will be reasonable to provide extended opening less frequently than once per week. As a minimum: Practices with list sizes of between 1,000 and not more than 3,000 patients will be required to provide, extended hours (i.e. 30 additional minutes of consultation time per every 1000 patients on a pro rata basis), one week in two. Practices with list sizes of 1,000 patients, or less, will be required to provide extended hours one week in four. Other Issues The core hours for services provided under the GMS contract remain unchanged. Where a practice has opted-out of out of hours provision, the provision for out of hours GP services remains the responsibility of the NHS Board. A contractor who has contracted to provide out of hours services and has also entered into arrangements for the Extended Hours Access Scheme will be required to provide extended hours over and above the out of hours provision.

4 Annex A Payment Arrangements Directions to Health Boards The Scottish Ministers give the following Directions to Health Boards. Contractors and Providers who have entered into an arrangement with a Health Board in terms of Extended Hours Access Scheme in the Primary Medical Services (Directed Enhanced Services) (Scotland) Directions 2012 ( DES Directions 2012 ) are to be paid 3.01 per registered patient per year by that Health Board. For the purposes of the Extended Hours Access Scheme, practice list size (i.e. the number of registered patients which a contractor / provider has) will be calculated on 1 st April, each year, except where the extended access arrangements start in-year; in these cases the list size will be the practice list size at the start of the immediately, preceding quarter. In the case of a new contractor or provider, the practice list size will be based on the initial list. Payments will be made on an arrears quarterly basis. Payment Verification Prior to issuing payments in accordance with the above paragraph, Health Boards must require contractors and providers who have entered into an arrangement with a Health Board in terms of the Extended Hours Access Scheme in the DES Directions 2012 to sign a declaration to confirm that they are meeting the requirements of the DES Directions 2012.

5 Annex B Practice 1 (List Size 5,100) Number of Thousands: (5,100 / 1000) = 5.1 Apply 30 mins per thousand: (5.1 * 30) = 153 minutes Extended Hours Each Week: 2 hours 45 mins* Practice 2 (List Size 1,200) Number of Thousands: (1,200 / 1000) = 1.2 Apply 30 mins per thousand: (1.2 * 30) = 36 minutes Extended Hours one week in two : 0 hours 45 mins* Practice 3 (List Size 700) Number of Thousands: (700 / 1000) = 0.7 Apply 30 mins per thousand: (0.7 * 30) = 21 minutes Extended Hours 1 week in four = 0 hours 30 mins* *Rounded up to nearest 15 mins