Relations between the government and the British Medical Association deteriorated further this week after the Health Secretary Alan Johnson sent a letter to all GPs in England urging them to accept proposals for longer opening hours.

The BMA’s GP Committee has been locked in discussions with NHS Employers since October to try and reach an agreement on extending surgery opening hours to evenings and at weekends, a flagship component of the government’s drive to improve primary care services.

But in December things took a nasty turn after the BMA accused the government of failing to consider doctors’ own proposals for longer opening hours, instead threatening to “impose a draconian contract if GPs won’t agree to the deal on the table”.

The government is looking for the provision of around three hours of extra appointment time per practice per week, and has promised a 1.5% additional investment in services in return. But Dr Laurence Buckman, Chairman of the GPC, said the plans would lead to a cut in GP practice funding with the removal of 135 points from the Quality and Outcomes Framework – an annual incentive and reward scheme for GPs – that would have to be earned back through the provision of extended hours.

The Association itself has proposed that an average practice of six thousand patients provide an extra two hours of surgery time, with further improvements to the QOF to encourage a greater focus on better care of patients with heart failure and osteoporosis, “leading to an improved quality of life for elderly patients”.

A ‘balanced’ offer
However, in his letter, Johnson insists that “a guaranteed 1.5% increase in practice income, combined with an additional 30 minutes opening per week for every 1,000 patients, represents a balanced offer that both increases investment in primary care and provides a better service for patients.”

But, according to Buckman, the 1.5% increase “refers to a future, as yet undecided pay award from the body that recommends doctors’ pay awards. There have been two years of 0% increases in practice funding and the government’s imposition would see practices lose an average of £36,000 in resources. This is money taken from the QOF and given to PCTs to use to fund extended hours, yet in some areas there is little demand for this.”

The Association is yet to make a decision on whether to accept the government’s proposal, and plans to carry out a UK-wide poll of doctors to gage opinion before making a decision. In the meantime, Johnson has encouraged GP practices to enter discussions with their PCTs on how to improve access, “either under the proposed national framework or under locally agreed arrangements”.

Commenting on the situation, NHS Alliance chairman Dr Michael Dixon told PharmaTimes in an emailed statement: “We are disappointed to see that negotiations have broken down in the way they have. It makes GPs seem as though they are somehow against the NHS – almost against their own patients - and that is not so.”

Need for longer hours varies
“Most GPs accept in principle the need for surgeries to open longer than most do now. They want to be able to talk to their patients and primary care trusts about exactly what is needed locally and how best to deliver what patients need. That varies from place to place and even from practice to practice.”

“GPs are worried about the future for their practices and their patients,” Buckman stressed. “We are being contacted all the time by GPs who are angry and upset about the bullying behaviour of the government and who fear that the government’s plans will damage general practice in this country”.

The Conservative party was also critical of Johnson’s move, with shadow health secretary Alan Johnson saying according to Pulse Magazine: “Just four years ago the government allowed a new GP contract to go ahead, which doubled the costs of providing out-of-hours care and led to worsening services for patients. Now they are trying to undo that mess with a letter”.