Chancellor Gordon Brown has hinted at plans to extend surgery opening hours to improve access to general practice when he takes over from Prime Minister Tony Blair following his retirement in July, according to media reports.
The current GP contract has been much debated since it came into force in 2004. A radical change was that doctors were given the choice of opting out of out-of-hours care (evening and weekends) for a pay cut of just 6%. Around nine million patients receive urgent primary out-of-hours care in England every year, according to the Committee of Public Accounts, and responsibility for these patients has now fallen to primary care trusts.
In addition, pay provisions under the contract have attracted some criticism, given that the average GP salary has capped £100,000 as basic pay is boosted by the new payment-by-results bonus scheme, at a time when the National Health Service is in financial dire straits.
In response to reports that Chancellor Brown may again alter the status quo, Dr Hamish Melrum, chairman of the British Medical Association’s General Practitioner’s Committee, said he intends to remind the future Prime Minister of the reasons behind the new GP contract which, he argues, addressed the “severe workforce shortage and low morale among GPs” at the time.
A ‘workforce issue’
“Longer opening hours is a workforce issue,” he stressed. “Family doctors have already pulled out all the stops to deliver top-quality services to patients under the new contract, but their work is intensive and much more complex than in the past as more procedures previously done in hospitals transfer to GP surgeries.”
Furthermore, if hours were to be extended, there would need to be a “significant increase in the number of GPs, practice nurses and all the other practice staff…along with all the back-up diagnostic services needed to make general practice work more efficiently,” Dr Melrum pointed out.
Commenting on the issue, Professor Mayur Lakhani, Chair of the Royal College of General Practitioners, told PharmaTimes UK News: “As a practising GP, I know that patients remain concerned about the arrangements for care in evenings, nights and at weekends and I suspect this is what Mr Brown is reflecting.”
“I do not think that this is an issue that can be ignored as it is important that the NHS is responsive to the legitimate clinical needs of patients," he said, adding: "We can tackle this problem and it is essential that GPs are given the opportunity and support to lead, influence and devise local schemes that improve quality, access and continuity of care.”
Public perception high
Meanwhile, it seems that the public’s perception of general practice isn’t all that bad. In a survey of 1.2 million patients over 2004-07 by independent researchers CFEP UK, more than 80% of patients rated their overall satisfaction with their GP visit as excellent (48.7%) or very good (32.3%).
“The Improving Practice Questionnaire patient survey is officially approved as part of the Quality and Outcomes Framework of the new GP contract,” said Dr Meldrum. “It tells us that, over the three year period, practices are responding to patients and offering them excellent access to first class healthcare.”