Open all hours?

The Government has clashed with GPs over negotiations to extend opening hours at surgeries.

Health Secretary Alan Johnson has written to every GP in England explaining why he wants surgeries to open at weekends and evenings.

And in an unusual move which indicates the strength of the Government's determination, the Department of Health was willing yesterday to release a copy of the Health Secretary's letter to journalists who asked for it.

"General satisfaction with GPs is high, and the quality of our primary care is admired across the world," Mr Johnson says in the letter.

"However, significant numbers of patients tell us that improving access to GP services should be a priority for the NHS. This includes not just greater choice of appointment times, but continuing improvements in ability to book advance appointments and fast access to GP appointments."

GPs today hit back, however, stressing that they are not against more flexible opening hours.

It is the system being proposed by the Government they don't like, said Dr John Givans, a retired Harrogate GP who is chief executive of the North Yorkshire Local Medical Committee.

The Government wants GP practices to open for an 30 minutes for every 1,000 patients on their books - which would mean average-sized surgeries being open for about an extra three hours a week.

But that was a one-size-fits-all approach to the problem which would actually harm patient care, Dr Givans said.

Because the Government would not allow practices to reduce the hours they were open during the day, inevitably it would mean doctors working longer hours.

That might mean locum GPs being taken on to fill the gaps. "And if you do that, patients are not going to get the sort of continuity of care they want," he said.

Doctors' leaders had proposed last year a more flexible system for extending opening hours, under which individual practices would decide what extended hours to open in consultation with their patients, Dr Givans said.

That model, which would have meant surgeries opening on average two hours longer, had been rejected by the Government.

It would also have meant the extended opening hours of surgeries in different areas could have been tailored to meet the needs of local populations. People living in rural communities were likely to have different needs to people living in cities, Dr Givans pointed out.

"GPs are not at all opposed to offering extended hours so that people don't have to take time off work to go to the surgery," he said.

"But what we would hope is that we could get back to sensible negotiations rather than having a gun held to our head and being told if we don't accept what the Government is offering, they will impose something much worse."

The argument

The Government wants GP surgeries to open for an extra half-an-hour for every 1,000 patients, in blocks of one-and-a-half hours.

For an average GP practice with 6,000 patients, this would mean opening an extra three hours a week.

The BMA is willing to have surgeries open for an extra two hours on average, the equivalent of 6.30pm to 8.30pm on a weekday evening or a Saturday morning surgery.

But the Government is demanding they open for three.

GPs also claim that by not offering more cash to surgeries to pay for the extra opening hours, doctors would be working longer hours - but expected to take a pay cut.

This is because their practices would have to pay to heat, light and staff surgeries during the extended hours - meaning that there would be less money for GPs themselves.

Big salary, but a big responsibility'

YORK GP Dr Brian McGregor is not going to pretend that GPs are poorly paid.

They are not, he admits. But the pay they get is fair for the work they do.

He himself earns about £82,000 a year for his basic practice work at the Gale Farm surgery in Acomb. On top of that, he gets paid extra for the evening and weekend hours he puts in with the GP out-of-hours service - money he uses to "send the children to private school", he says.

But it takes ten years training altogether to qualify as a GP, he says - and the work involves taking huge responsibility for the quality of patients' health. His salary is not unreasonable, therefore, he insists - especially when you take into account the sums lawyers and accountants earn.

Yet now the Government expects GPs to take a pay cut for working longer hours, he says.

That is effectively what is being proposed, because the Government will not pay extra for the extended hours it expects surgeries to open.

Support staff will have to be paid to attend the extra hours, he says - and surgeries will have to be heated and lighted, meaning there will be less money for GPs themselves.

"Would you expect to work every Saturday and get less money for it?" he asked.

GPs already work gruelling hours, Dr McGregor says. He himself works 75 to 80 hours a week, he says.

He admits that is exceptional, and is because he does extra paid work for the out-of-hours service, as well as being on local medical committees. But GPs at his practice routinely work 8am-6.30pm four days a week, with a half day a week for educational purposes and another half day for essential admin work.

If the Government has its way, he says, there will be GPs working 12-hour shifts, from 8am to 8pm, because Ministers won't allow any reduction in daytime surgery hours.

The obvious solution might seem to be for GPs to work in shifts, with some starting earlier and others finishing later.

But the Government won't allow that, Dr McGregor says, as it would be seen as a reduction of daytime availability.

Yes, Dr McGregor admits, in 2004 GPs received a good settlement. But since then, he says, their salaries have not gone up.

They had a zero per cent increase last year, and the same again this year - and expect the same next year.

He is genuinely puzzled by the attitude of some people that GPs earn too much.

"What do people think a GP is worth?" he asks.

"For that degree of commitment, and that degree of training and responsibility? What do they think a GP is worth?"

At the end of the day, he points out, GPs are not against extended opening hours. He himself works regularly at weekends and evenings because of his out of hours work.

But, he asks, why should they get paid less for doing it?

More user-friendly hours would help patients'

York mum-of-two Fiona Hick admits that because she only works part-time, she finds it easier to get to the GP than most working mums.

But it can be very difficult for people who work full-time to get to see their doctors, she says. "It can be hard for them to take time off to go to the GP," she said.

Fiona, from Dringhoiuses, particularly worries about her husband, Andy, who runs his own business and is very busy.

He tends simply to not go to the GP at all, she says. "He doesn't bother seeing a GP, even when he's got something that he really should be seeing someone about," she said.

As a mum, she adds, weekends when surgeries are closed can also seem very long if one of her children - Imogen, eight and Evan, six - are not well.

The out-of-hours service is really for emergencies only, she says. But with a child, it can be difficult to know what is an emergency and what isn't.

"Parents rightly tend to be over-cautious."

For that reason, she would be in favour of some kind of system where patients could access GPs at evenings and weekends on a non-emergency basis, she said.

Richard Mowbray agrees. A partner in a York mortgage advice service, he finds it a "nightmare" getting to see a GP. When he first came to York he registered with a practice in the city centre, he said. It had since moved to new premises on the outskirts of the city.

"And it is a nightmare to get to it.. We're fairly annoyed about it. And I do think it would be a good idea for surgeries to keep more user-friendly hours. You can't just nip out - it is a major undertaking."

James Player, of charity Age Concern York, agreed it could be difficult for people working full-time to get to their GP - especially if they were commuters who lived a long way away from where they worked.

Saturday morning openings would certainly help them, he said.

But he would be against any changes that reduced the number of surgery hours on ordinary weekdays.

Those were very important for elderly patients, he said - who often found it easier and safer to go to their GP in the daytime during the week.

He would also hate to see any increase in surgery hours being at the expense of home visits.

They were vital for elderly people, he said - and must continue.

Out-of-hours doctors service

The out-of-hours doctors service in York and North Yorkshire is run by the primary care trust.

The service runs from 6pm to 8am and at the weekends, and is accessible through patients' own surgery: each practice has the phone number on their answer phone. Patients may receive advice over the phone, or they may receive a visit from a qualified nurse or GP, depending on circumstances.

Patients who have a problem out of normal surgery hours can also phone NHS Direct on 0845 46 47, or online at: www.nhsdirect.nhs.uk. For minor injuries patients can also access care through minor injuries units or the Walk-in Centre at Monkgate in York.