Opinion  

It is unclear what this means for practice nurses. The DES seems to apply only to GPs, but there will be 'local flexibility'. Does this mean nurse practitioners could do these hours?

In surgeries that do open later some GPs will inevitably expect other staff to come in and help them hold the fort. Or, if not, nurses may be expected to change their hours to cover earlier slots and free up a GP for evenings and Saturdays.

Those that decide not to open longer may attempt to recoup the money they lose by, for example, freezing staff pay, cutting services or reconsidering staffing levels. Meanwhile, practices thinking about employing a nurse practitioner may be more tempted by a salaried GP (even though it is more expensive) because the GP will be able to take on some of the extra hours.

So, although the DES is specific to GPs, many nurses will feel its impact. It is therefore unfortunate that no one seems to be interested in what nurses or other staff think about all of this. One would hope GPs are discussing these issues with their teams and that their views will be taken into account when a decision is made about whether to open longer.

The government has clearly not thought about the effects on other staff, which is unsurprising. When the DoH and the BMA negotiated the GMS contract in 2004, ministers did not seem to realise that it would be practice nurses doing the bulk of the extra work - or that GPs would be unlikely to share the extra money they received for this with staff.

The DoH has gone into battle with the BMA over extended hours in an effort to claw back some of the ground it lost in 2004. However, it has forgotten that these skirmishes impact on other professions, and that nurses and practice staff could well be caught in the crossfire.

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