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Last Updated: Tuesday, 25 September 2007, 13:09 GMT 14:09 UK
Is the PM gearing up for GP fight?
By Nick Triggle
Health reporter, BBC News

The government wants to give patients better access to family doctors.

But the profession doubts there is really demand for it. So why are ministers gearing up for a battle?

GP
GPs are coming under pressure to extend surgery hours

In the non-existent contest for the Labour leadership, Gordon Brown was surprisingly reluctant to make bold statements about what he would do.

Instead, the then future prime minister - in a field of one during the summer - preferred to stress that he wanted to listen.

There was one exception - GP opening hours.

The prime minister entered the debate over a row about the care of London mother Penny Campbell.

The independent inquiry found the London mother-of-one died after not having septicaemia diagnosed despite seeing eight out-of-hours doctors over the Easter weekend two years ago,.

Mr Brown said better access to doctors, drop-in centres and local health facilities was needed.

Whenever doctors I have known have run evening or Saturday morning surgeries they have not been well attended
Richard Vautrey, of the British Medical Association

It marked the start of sustained campaign which has been evident throughout Mr Brown's first few months in charge.

And it has again raised its head at the Labour conference in Bournemouth with both the prime minister and his new health secretary, Alan Johnson, saying opening hours had to be extended.

It is also a major theme of the NHS review being carried out by Sir Ara Darzi, a practising surgeon and government minister.

And with the review not due to publish its final findings until next year, ministers have been able to avoid setting out just how they plan to achieve it.

But in recent weeks the first signs of what is likely to happen have begun to emerge - and it seems the trusty "stick and carrot" technique will be deployed.

Last week the Department of Health was briefing journalists that the government was set to meet with leading high-street firms, such as Virgin and Boots, to increase competition into the GP market.

Demand

It has been suggested that in areas where there is demand for longer hours, the government would be prepared to see companies move into the primary care market if NHS doctors refuse to respond.

One Department of Health source said ministers believe the threat of private sector encroachment will force GPs to the negotiating table.

Ministers will then sweeten the bitter pill of longer hours with the offer of more money.

Under the GP contract, doctors are effectively paid a bonus for providing certain services and this could be tweaked to include incentives for extended opening.

But such moves seem at odds with the government's stated intention to create a "clinically-led" health service.

Dr Hamish Meldrum, chairman of the British Medical Association, said: "It is ironic that on one hand Mr Johnson talks about clinical engagement and yet when it comes to GP hours he does not approach the BMA.

"We are always willing to talk about how the service we provide can be improved, but obviously increased opening times and services need considerable resources."

Chris Ham, a former government adviser and professor of health policy, believes the interest in opening hours dates back to 2004 when a new GP contract was introduced.

Penny Campbell
Penny Campbell died in 2005 after seeing eight doctors

The deal allowed doctors to give up responsibility for emergency out-of-hours care and also led to a huge hike in salaries.

And while this drive is about routine care rather than emergency there is a feeling within government that GPs owe patients.

Professor Ham said: "The deal was very good for GPs, they got extra money for shorter hours.

"Patients have not benefited as much as they should have so it seems fair that extended hours are provided where demanded."

And this is another bone of contention. Doctors are not convinced there are sufficient patients wanting such services.

Happy

A recent poll of over 2m patients by Mori for the government found 84% were happy with opening hours.

Dr Richard Vautrey, deputy chairman of the BMA's GPs committee, says: "There is just not the demand. Whenever doctors I have known have run evening or Saturday morning surgeries they have not been well attended.

"And it is not just about having a GP there, you need a practice nurse, receptionist, blood testing facilities. It is an expensive way of providing care."

But, as always with statistics, it can be viewed the opposite way round - that is to say nearly a fifth of people are not happy.

Michael Sobanja, chief executive of the NHS Alliance, which represents health trusts, said: "Not everyone wants longer opening, but some people do.

"You can see how it would be particularly helpful to commuters and that in turn raises questions about registration.

"Why can't we factor in a way of allowing people to visit GPs they are not registered with? These are all legitimate things to be looking at."


SEE ALSO
Brown calls for better GP cover
25 May 07 |  Health
Taming the NHS workforce
28 Jun 07 |  Health

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