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PBC the answer to extended hours, says NHS Alliance

A new primary care report from the NHS Alliance rejects a "one sizefits all" approach to extended surgery hours, and suggests practicesshould have the power to come up with their own solutions throughpractice-based commissioning (PBC).

"A limited focus on GPopening hours risks the solution becoming nothing more than a tick-boxexercise that fails to improve care," the report cautions.

The authors of the report, entitled In Sickness and In Health,warn that Quality and Outcomes Framework points could be awarded to GPs"without taking account of what patients need and want, whether care isimproved as a result - and regardless of whether patients actually doaccess services at the times."

Instead, the NHS Alliance sayspractices should be able to consider the needs of their localcommunities and devise their own solutions for extended hours whereappropriate.

The report says: "PBC groups may wish tocollaborate to provide scheduled care during extended hours, eitherthrough a shared rota system or by commissioning an alternativeprovider."

It also suggests that existing out-of-hours providerscould be commissioned to provide scheduled extended hours care inaddition to urgent care.

"Practices, collaborating with theirpatient participation groups and the new Local Improvement Networks(LINks) should work with their PBC clusters to design local solutionsto local problems," the authors advise.

Elsewhere, the reportcalls for the establishment of "integrated care organisations" (ICOs) -a healthcare model in which clinicians and managers in primary,community and secondary healthcare collaborate to commission andprovide healthcare services to their local population.

TheAlliance also suggests the establishment of a "new type of doctor" tobe employed by an ICO - the "Community Specialist Consultant", whocould provide an ongoing specialist link between primary and secondarycare, particularly for patients with long-term conditions and complexneeds.

"Working in the community should be seen as a genuinecareer option for specialists and consultants, just as it is for GPs,"said Consultant Paediatrician Dr Minoo Irani, who leads the NHSAlliance specialists' network.

Responding to the Alliance's newreport, Lord Ara Darzi, the health minister who is carrying out the NHSNext Stage Review, said: "I share the prime minister's view thatprimary care is the lynchpin of a 21st Century NHS and welcome thisimportant contribution to the debate on its future.

"The NextStage Review will aim to build on the strengths in primary care,deepening the focus on health promotion, delivering more personalised,accessible and integrated services and rewarding high quality care -objectives which the NHS Alliance clearly shares."

NHS Alliance