The government wants surgeries to open for a minimum of 30 minutes extra per week per 1,000 patients on the list, in minimum blocks of 1.5 hours. This only refers to GP appointments and GP appointments that run concurrently will not count. If a practice decides not to open extra hours it will, on average, lose £18,000 of income.

The cheapest way for a surgery to provide these extra hours is for a GP to stay late on their own. This raises huge safety concerns and, quite clearly, is not how general practice works.

General practice is a team effort and GPs not only need reception staff to cover extra hours, they may want nurses as well. Practices in Wales have been given the flexibility to include nurses in their plans, while a fund of £2.65 million is available to practices in Scotland that want nurses to work extended hours.

PCTs in England also seem to be recognising that the government's DES will not be the best way to deliver the access that patients want. As our investigation shows, 13 per cent of PCTs are planning to provide extra cash to cover nurse time under more flexible local enhanced services (LESs).

It is good to see that trusts recognise nurses have a vital role to play in improving access and are a key part of the practice team. However, these LESs must translate into a fair deal for nurses on the front line.

It is imperative that nurses do not feel forced or pressurised into working extended hours, or changing their existing hours. And, if nurses do decide to work later, they must be compensated appropriately, which means antisocial hours' should apply.

Independent Nurse is interested to find out about experience of extended hours. Are you working later and, if so, are you paid appropriately? Take part in our survey at www.healthcarerepublic.com/surveys.

Emma Bower, editor, Independent Nurse, emma.bower@haymarket.com