What are the considerations for providing out-of-hours services?
Evening and weekend clinics, on-call access and home visits: what to decide before you extend your hours as a private GP.
The short answer
Before offering out-of-hours care, decide exactly what you are offering (extended clinic hours, telephone access or home visits), check that your indemnity and regulator registration cover it, and make sure you can run it safely with access to records, results and a clear route to NHS urgent care. Patients should always know what to do when you are not available, and you should not let extra hours erode rest for you or your staff.
Key points
- Be specific: extended clinic hours, on-call telephone access and home visits carry very different risks.
- Tell patients clearly when you are available and to use NHS 111 or 999 when you are not.
- Check that your indemnity covers the hours, settings and remote work you plan.
- Remote and home-visit work needs records, prescribing and results handling that work at any hour.
- If you employ staff, you must assess lone-working risks and keep in touch with them.
Decide what "out of hours" means for you
In the NHS, out-of-hours care is a commissioned service with its own contracts, triage and cover. A private GP offering "out-of-hours" care is usually doing something narrower, and it helps to name it precisely:
| Model | What it involves | Main risks |
|---|---|---|
| Extended clinic hours | Early morning, evening or weekend appointments at your usual site | Staffing, lone working, results arriving when you are closed |
| Remote access | Telephone or video consultations outside normal hours | Assessment without examination, prescribing safely, no access to NHS records |
| On-call for existing patients | A number members can ring for advice | Fatigue, expectations of instant response, cover when you are away |
| Home and hotel visits | Visiting patients where they are | Personal safety, emergency equipment, travel time |
Most private services start with extended clinic hours, which are low risk and in demand from patients who work. On-call access and night visits are much harder to sustain alone.
Patients must know what to do when you are not there
You are not replacing NHS urgent care, and patients should not think you are. State your hours on your website, booking confirmations and voicemail, and say what to do outside them: NHS 111 for urgent advice and 999 for emergencies. If you offer an on-call number, define what it covers and the response time you can realistically give.
Safety-netting matters more when you may not be reachable. Give clear written advice at the end of each consultation about what to watch for and where to go. Medical Protection’s telemedicine guidance stresses very clear instructions on safety-netting and follow-up for remote consultations.
Registration and indemnity
- Regulator. In England your CQC statement of purpose must describe the kinds of services you provide and the locations you provide them from. Adding home visits or a remote service can change that, so update it and notify the CQC where required. See CQC registration by service.
- Indemnity. Tell your medical defence organisation about the hours, settings and consultation types. Remote consultations and patients who are abroad at the time need specific cover. See insurance for a private GP practice.
- Remote prescribing. GMC guidance applies the same standards remotely as face to face. If you cannot assess the patient adequately or get the information you need, do not prescribe. Be especially cautious with medicines open to misuse.
Making it safe in practice
- Records. You need the full record wherever you are working, and your notes must be written up at the time. A cloud-based record makes this far easier than paper.
- Results. Agree with your laboratory who they phone with urgent results when you are closed, and what happens if you cannot be reached.
- Emergency equipment. Home visits need a portable kit that matches what you might meet. See emergency drugs for private GPs.
- Cover. Decide what happens when you are ill or on holiday. If there is no cover, patients need to know that access pauses.
- Handover. With consent, send a summary to the patient’s NHS GP the next working day, as you would for any consultation. See sending notes to the NHS GP.
Staff, lone working and fatigue
If you employ staff, HSE guidance says you must include lone workers in your risk assessment, train and supervise them, keep in touch with them and respond to any incident. For home visits, that usually means a shared diary of visits, a check-in when each visit ends and a plan if someone does not check in. The same good habits protect you if you are self-employed.
Fatigue is the quieter risk. The BMA recommends limits on direct patient contact within a session for NHS GPs, and the reasoning applies equally to private work stacked on top of an NHS job. Build in rest, and do not offer an on-call promise you cannot keep while also working NHS sessions.
Pricing and demand
Evening and weekend appointments are often the easiest to fill, and many services charge the same as daytime to keep things simple. Home visits and on-call access take more of your time and usually carry a higher fee or sit within a membership. Whatever you choose, show the full price before booking. See how much to charge.
Outside England
NHS 111 operates in England and Wales (as NHS 111 Wales). In Scotland patients call NHS 24 on 111, and in Northern Ireland the out-of-hours GP services are accessed differently. Tailor your patient information to where your patients are, and check your regulator’s requirements if you are in Scotland, Wales or Northern Ireland.
Frequently asked questions
Do I need separate CQC registration to offer evening clinics?
Not usually, if the service and location are already covered. Home visits or a new remote service may need your statement of purpose updated, so check before you launch.
Can I charge more for weekend appointments?
Yes. Private fees are for you to set, as long as the price is clear before the patient books.
Should I give my personal mobile number for out-of-hours access?
It is safer to use a practice number that can be diverted and logged. That keeps a record and lets someone else cover when you are unavailable.
What if a patient contacts me with an emergency out of hours?
Tell them to call 999 or go to the emergency department, and record the contact and the advice you gave. Do not attempt to manage an emergency remotely.
