I’ve been expecting the new contract changes to arrive, so I’ve been keeping an eye on my emails more closely than usual.

At first glance, some of the changes seem relatively innocuous – that is, until you get to the ‘work late’ and ‘Saturday too’ bit.

It’s just slipped in there, almost as if we might not notice it, among the great raft of changes that are headed our way.

Strikingly, the ARRS will be expanded to include non-clinical support and Band 4 roles. It’s a good job really, because I suspect that the need to work evenings and Saturdays will be the straw that breaks the camel’s back for some of our existing staff.

We’ve always struggled to get staff to work extended hours, and while flu-clinic Saturdays are generally a total riot, I can’t imagine that I’m going to have staff queueing up to work them every week. As they haven’t yet released the Network Contract DES, I’m not sure how they’re planning on funding this, but I suspect that, as usual, there won’t be a huge uplift to our budget.

Assuming that they’re not going to raise the budget by much, are we just expected to move the capacity across the week? If that’s the case, I’m thinking we’ll need a consultation period with staff about the change of hours. I get enough grief when I try to get someone to swap a late shift, never mind asking someone to take it on permanently! Of course, I understand their reluctance; staff have often moved into general practice to try and regain a work-life balance after having worked shifts for years.

The letter appears to suggest that this amounts to the provision of normal services, across the team, with staff just working late every night and extending into Saturday. As we can’t adequately staff our existing hours, how are we expected to conjure up the extra? There has to be GP cover, so where are they suggesting that we find an extra day’s worth of GP time from? We’re currently paying GPs £££££ for regular sessions, as we can’t easily recruit, so are we looking at a situation where recruiting into those sessions will attract a premium? Given that a GP session is a nominal 4 hours and 10 minutes, does that mean that afternoon surgeries will need to start at 4pm? If they’ve worked a morning session, then is this now the equivalent of a split shift, or will the morning sessions be starting later too? What about blood requests and collections? They don’t happen in the evening, so there are going to be restrictions on what we can deliver.

I had to laugh as I read the paragraph about unused appointments… unused appointments – what the heck are they? It’s simply indicative of the inability of the folks at NHSE to actually see what’s in front of their faces! When do you suppose any of them last visited a practice this side of the desk? Or worked a shift, a day, a week in a practice, getting their hands dirty so to speak? I’d hazard a guess that the answer is somewhere between zero and the sum of diddly-squat. I’m tempted to send them a gold-plated invitation to see if they’d deign to visit, because I can’t see any other way to get the powers that be to understand why I think this is like attempting to boil the ocean. For practices where Saturday is a holy day, or where there are other religious needs to be taken into account, I can only hope that the catch-all “as agreed with the commissioner” will cover that.

I’m further astounded by the idea that ICSs will be consulted on the GP contract going forward. The idea that primary and secondary care covering massive geographical and population areas will all rub along happily for the same funding is at best optimistic. As we are barely consulted on the contract as it is, how this can be seen to be reassuring is completely beyond me.

So, if anyone has any ideas about how I get a quart out of a pint pot, I’d be very happy to hear them!

Paula