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GPs’ leaders have found themselves fighting back over plans—stemming from 10 Downing Street—to force general practices to open for longer. The government said just before Christmas that it intended to impose a contract on GPs that could mean that practices that don’t comply will lose as much as £36000 (€49000; $72000) a year.
The BMA leaders argue that the proposals don’t reflect what most patients want and that doctors will be too tired to provide a good service.
At a briefing just before Christmas, Laurence Buckman, chairman of the BMA’s General Practitioners Committee, told journalists that the government had “effectively put a gun to our head.”
He said, “We are being bullied so that the prime minister can tick a box next to a politically driven target without regard for the damage this could do in the long term to patient services in primary care.”
Within a matter of hours the government responded by announcing sweeping changes in the funding arrangements for general practices in the quality and outcomes framework (QOF). Many of these would be withdrawn to fund the proposed new opening hours, says the BMA.
The BMA argues that the proposals will undermine care for the patients with the most need. “GPs will do their best to continue to provide good quality care, but Gordon Brown’s political objective will inevitably affect the chronically ill,” said Dr Buckman.
The government wants doctors to open their surgeries for three more hours a week. Surgeries normally close at 6 30 pm, and merely adding an extra half an hour each evening would not meet the government’s desire to make it easier for people at work to get to their doctor. It is understood that the prime minister, Gordon Brown, wants to see surgeries opening until 8 pm one night a week.
Dr Buckman said that a Department of Health survey of patients’ experiences conducted last summer (the GP patient survey 2007, available at www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpatientsurvey2007/DH_075127), had shown that 84% of patients were happy with the current opening hours of their practice. “A significant number of GPs do not consider longer opening hours to be an efficient use of resources,” he said.
The government has rejected an alternative proposal from the BMA and now intends to consult the profession over the next 13 weeks, before introducing the changes in April.
Dr Buckman was at pains to point out that talks “have most definitely not broken down,” and he explained that the 13 week consultation was a legal requirement where a change in the contract was proposed. Consultation would therefore begin immediately, despite the BMA’s objections, because of the government’s intention to introduce the change in April’s pay round.
The proposals, said Dr Buckman, were not based on evidence and would be at the expense of quality of care. He argued that patients of his who commute to work would in any case prefer early morning appointments to those after work.
Doctors who didn’t want to work the extra hours themselves could in theory provide them through a locum. “But that would be financial suicide,” said Dr Buckman. “And I don’t accept the case that any doctor will do. Any doctor will not do—what patients want is their own doctor and continuity of care.”
He fears that if practices lose out on funding because they don’t provide the additional service, the cash will instead go to primary care trusts to fund the new health clinics proposed in health minister Ara Darzi’s interim review of the NHS (BMJ 2007;335:739, 13 Oct doi: 10.1136/bmj.39360.699977.DB —which could potentially be provided by the private sector.