An overwhelming number of GPs in the UK have given a vote of “no confidence” in the government’s handling of the National Health Service, and believe the way changes to the GP contract were negotiated is “unacceptable”.

The results are from poll of doctors carried out by the British Medical Association to gage opinion on the two choices of extending patient access to GPs put on the table by the government for the 2008/9 GP contract.

There has been a growing drive to provide better access to primary care since the issue came up time and time again during Lord Ara Darzi’s consultations with the general public over the National Health Service as part of his Next Stage review. But although the doctor’s union agrees that GP hours could be extended to better meet patients’ needs, it has been at loggerheads with the government for some months on how to best go about it.

Talks between the government and the BMA disintegrated towards the end of last year after the government allegedly refused to accept the Association’s own proposals for the expansion of GP access, instead putting forward two options on the understanding that, if the organisation doesn’t agree to the first one (Option A), then the second (Option B) will be imposed.

Under Option A, the government has put forward extended access of 30 minutes per week per 1,000 registered patients - in blocks of 1.5 hours after 6.30pm or for one hour prior to 8.00am or on Saturday morning - depending on agreement between the practice and the primary care organisation and local patients’ wishes. An additional investment of 1.5% in services and reallocation of 58.5 points from the Quality and Outcomes Framework (38.5 from the holistic/organisation domains and 20 from the patient experience domain) would be made available to support these arrangements.

Under Option B, however, 135 points would permanently removed from the QOF, including clinical areas such as flu vaccination and management areas such as computer security. Funding would be allocated to PCTs for them to agree local contracts for longer opening with any practices - including newly established private APMS practices - but “experience has shown that it is likely that only a proportion of the funding would end up with any general practices if allocated to PCTs,” the BMA argues.

Of 27,000 GPs responding to the BMA’s poll, 96% opposed both these proposals but, being forced to make a choice, 92% said they would favour Option A on the basis that it poses less of a risk to patient care. Furthermore, 97% of English GPs said they had no confidence in the government’s handling of the NHS, while 98 out of every 100 said the government’s method of negotiation was unacceptable.

In addition, 93% of GPs said they believe the government’s policy of bringing private providers into NHS general practice will be “bad for patients and the service as a whole”. But, in response to this claim, Dr Neil Bentley, director of public services at the Confederation of British Industry, argued: “It is plain wrong to suggest that bringing in private providers will be bad for the NHS. In other areas of the health service they have delivered high quality care and led to satisfied patients. Good family doctors should have no reason to feel threatened by such proposals.”

Government should ‘take heed’
In light of the results, Dr Laurence Buckman, Chairman of the BMA’s GP Committee, advised that the government should “take heed” of the strength of opposition revealed by the poll. “It cannot be good to have such a key part of the health workforce feeling disengaged from the way the government is handling the health service. The effect can only be corrosive and in the long term it is not a good way to get the best service for patients”, he warned.

And Bentley agreed that the government should “push for more flexible opening hours for patients”, but added that “these initial attempts to extend access must not be seen as an end in themselves” and that “wider and deeper reforms will be needed if we are to get GP services that are truly patient friendly”.

According to Buckman, GPs are willing to put in the extra time to extend access to their services, but he stressed that doctors believe they are being forced into and an “unrealistic vision of extended hours”, and that “ patients will not get the level and flexibility of service in extended hours that they both expect and deserve”.

However, he concluded that “it is time to draw a line under this”, and promised that the Association will now focus on putting the plans for longer surgery hours into practice.

Using the surplus to boost care
The NHS Alliance suggests tapping into the predicted NHS surplus - which is estimated to be around £1.8 billion - to help ensure that extended surgery opening hours offer real benefits to patients and do not become a “tokenistic exercise”.

It points out that even if GPs are available for appointments in the evening or on Saturday mornings, it will not help patients if they need to come back during normal working hours because certain facilities are only available at these times, and says that any excess funds generated by the NHS should be used to make sure that certain services are also available during the extended opening hours.

“We have an extraordinary opportunity to provide improvements patients want and need [and] a significant part of the NHS surplus should be released to support extended access,” stressed the organisation’s chairman Michael Dillon.