One of the key aspects of primary care service provision is ensuring patients have access to appointments outside of core hours. Over time, the structure of these additional access services has evolved, leading to some confusion over what is required of general practices, particularly with the introduction of the Primary Care Network (PCN) Direct Enhanced Service (DES).
Extended Hours and Enhanced Access are two distinct but related concepts. Extended Hours was historically an optional service that individual practices could offer under the General Medical Services (GMS) contract. This required practices to provide additional patient appointments beyond the standard NHS core hours of 8:00 AM to 6:30 PM. The service was voluntary, meaning practices could opt in or out depending on their contractual preferences.
With the introduction of PCNs, the NHS moved towards a more structured and network-wide approach to out-of-hours access. The Extended Hours requirement was incorporated into a new system called Enhanced Access, which is now delivered at the PCN level rather than by individual practices. This change was designed to create a more consistent and accessible service for patients across larger populations.
Enhanced Access is a mandatory component of the PCN DES. Under this arrangement, PCNs must ensure that patients have access to routine appointments in the evenings and on weekends. Specifically, the requirement is for practices within a PCN to collaborate and offer additional appointments between 6:30 PM and 8:00 PM on weekdays, as well as between 9:00 AM and 5:00 PM on Saturdays. These appointments must be a mix of face-to-face, telephone, and online consultations to meet patient needs.
For practices that choose not to participate in the PCN DES, there is no longer an obligation to provide Extended Hours under the GMS contract. This means that a non-participating practice is not required to offer appointments beyond core hours. However, the responsibility for delivering Enhanced Access still remains with the PCN as a whole. Even if an individual practice opts out of the DES, patients registered at that practice should still be able to access evening and weekend appointments through the PCN’s wider provision.
It is important for practices to understand how these changes affect their contractual obligations and patient services. PCNs must ensure they are meeting the requirements of the Enhanced Access scheme, including appointment availability, workforce planning, and patient communication. Practices that are not participating in the PCN DES should liaise with their local commissioners to confirm what alternative arrangements, if any, they need to put in place.
Where a practice has signed up to the Network Contract DES, it is obliged to offer extended hours access, and from 1 October 2022 enhanced access, to its registered patients via the PCN.
It will be for the PCN to determine how that offer is made available to all its registered patients.
For extended hours access (until October 2022), the additional appointments provided by a PCN are to be held at times that take account of patient’s preferences and are outside core hours.
For enhanced access (from October 2022), the Network Standard Hours (NSH) will cover 6.30pm-8pm during the week.
a PCN’s minimum number of appointments per week may:
i. be delivered concurrently where they exceed the NSH; and/or
ii. with agreement from the commissioner, a proportion may be delivered in continuous periods of at least 30 minutes outside of the NSH to better meet the needs of the PCN’s patients, for example, to:
• provide appointments prior to 8am on weekday mornings or 9am on Saturday morning; or
• provide appointments after 8.30pm on weekday evenings or 5.30pm on Saturday evenings
PCNs have the flexibility to sub-contract extended hours access or enhanced access services to other providers.
It will be up to the PCN to determine the delivery model for extended hours access and enhanced access, but PCNs will need to ensure this service is offered to the entire PCN population.
For Enhanced Access from 01 October 2022 to 31 March 2023, payments under the Network Contract DES will be made using PCN Adjusted Populations. The formula used to calculate these populations includes a 15% adjustment to recognise inequalities and unmet need, and the same Adjusted Populations are used for the calculation for the number of minutes which PCNs are required to provide in Enhanced Access (60 mins per 1000 population, based on the PCN Adjusted Population).