Doctors and ministers are at loggerheads over extending GP hours.
By Nick Triggle
Health reporter, BBC News
Both sides insist they have the patients' interests at heart. But is the public really unhappy with GP opening and, if not, what is this row all about?
GPs got a new contract in 2004
On the face of it, longer GP opening sounds like a great idea.
Who would not want to be able to pop into their local surgery on the way home from work in the evenings?
But general practice is not like Tesco's and cannot necessarily cater to the 24-hour consumer society that has emerged.
Any extension needs to be achieved within a finite budget and this raises the question of cost-effectiveness.
The government has said it is pushing for longer hours to meet the demands of patients.
As evidence, ministers point to a survey of over 2m patients last year.
The poll by Mori, the largest-ever canvass of patient's views, showed 84% were satisfied with access.
But Professor Helen Lester, a GP expert from Manchester University's National Primary Care Research and Development Centre, says the devil is in the detail.
"If you take a closer look at the figures only 4% of the 16% who are not satisfied want longer opening in the evening. So do we really need a new system, or just a bit more flexibility?
She points out that the group most likely to want evening surgeries is young men and this is the very group that is least likely to use GP services.
There are 291m consultations a year or - in other words - 800,000 a day.
And by far the most frequent users of these are the over 75s and under threes - both of which are largely free to attend during regular hours.
By comparison, men aged 16 to 44 only have four consultations a year on average - half the number of the elderly.
Professor Lester says: "Logic would say you design the service around the 84%, while taking into account the views of the others. Anything else, would not be the most appropriate use of resources."
Nonetheless, the Patients Association is adamant reform is needed - even if longer opening is not necessary everywhere.
Association spokeswoman Katherine Murphy says: "What is sad about this debate is that it is all about the government and doctors.
"Meanwhile, patients are struggling to access services. Some of that is down to opening hours, but some is just to do with simple things like booking appointments."
However, many believe this debate is not just about hours.
Instead, Nick Goodwin, from the King's Fund health think-tank, says it is linked to the GP contract introduced in 2004.
This was the deal which saw average doctor pay break through the £100,000 barrier, while allowing them to give up responsibility for being on call during the night and at weekends.
Mr Goodwin says: "GPs got a particularly good deal and the government wants to claw something back.
"But, from the BMA's point of view, they don't want to be seen giving in on this.
"And they also warn that patient care during the day could be affected. The trouble is both sides are in the right to some extent and that is why it is so hard to reach a resolution."