The British Medical Association (BMA) has claimed the government is threatening to impose a "draconian contract" on GP surgeries, after it rejected a package of proposals over extended hours put forward by the General Practitioners' Committee (GPC).
Since October, the GPC and NHS Employers have been involved in negotiations aimed at coming to a UK-wide agreement on extending opening hours in the evenings and at weekends.
These proposals did not involve additional funding, but practice staff would have been paid for their longer service through a relocating of existing financial resources already allocated to access and Choose and Book.
Dr Laurence Buckman, GPC Chairman, said GPC negotiators "have been intent on reaching a deal which balances the competing demands of offering extended hours whilst preserving a good service to the large majority of patients who want to attend during normal hours."
The GPC proposals would have led to an additional two hours of surgery time each week – equivalent to an evening surgery from 6.30–8.30pm or a Saturday morning surgery.
Practices would also have been encouraged to focus on improving care in several clinical areas, including heart failure and osteoporosis, by making alterations to the Quality and Outcomes Framework (QOF).
However, Dr Buckman announced that the government has rejected these plans, and intends to impose a contract on GPs resulting in at least an additional three hours of surgery time each week, "whether patients want this or not."
Dr Buckman said: "We believe the government's method of negotiation is nothing short of a disgrace. They have effectively put a gun to our head and said if we don't accept their proposal they will impose a more draconian contract.
"The vast majority of our patients, and in particular those with chronic diseases or mothers with young children, prefer to come to surgeries during the day. They will be the ones who lose out if GPs are forced to work differently."
Dr Richard Vautrey, GPC Deputy Chairman, said the government's demands "show no understanding of the real needs of the majority of patients we are serving."
Dr Buckman said: "We are disappointed and angry that the government is not listening to GPs. As family doctors, we understand the needs of patients, which is why the government gave us the vital role of commissioning healthcare. But on something as important as this they refuse to listen to us.
"We are being bullied so that the Prime Minister can tick a box next to a politically driven target without regard for the damage this could do in the long-term to patient services in primary care.
He also said: "if they are not prepared to listen to our proposals, one of the few conclusions that we can reach is that the prime minister does not really want to reach a deal with GPs. We could then assume that the issue relating to extended hours is really a smokescreen to hide the government's intent to privatise general practice as quickly as possible."
However, Dr Buckman added: "We will offer to keep on negotiating with government while we seek the views of family doctors throughout the UK. We hope that the government will take up this offer and listen to us rather than force GPs to work in a way that reduces care for the majority."
Your comments: (Terms and conditions apply)
"This will be the death of small practices. Single-handed practices with one doctor will need to cut daytime surgeries down to provide evening surgeries. No doctor can function well with a 12-hour day. Unless a lot of extra funding comes along with this, the smaller practices will not be able to cope. I would not ask one receptionist to work alone in this area until 8pm of an evening. I have a very limited staff, and those I do have will not want to change daytime hours for evening ones. This will cost the practice in training new staff and funding their hours, along with the extra heating and lighting costs" – Name and address supplied
"Yes, I agree. There appears to be no 'patient drive' for these changes, and the whole of primary care will have to lengthen service provision hours and dilute the service in the core hours" – Chris Simmonds, General Manager, Doncaster
"The government sees GPs and their services as easy targets. They also believe the public is on their side, which is why they lobby the media; perhaps the GPC should do the same: give the media some facts about PCT behaviours that emanate from the DH, and how these behaviours have adversely affected primary care providers and their patients directly" – Name and address supplied
"When did it become unnacceptable to take time off work to attend to one's health? Years of trade union pressure and sunsequent employment legislation means that we have the right to take (in most cases paid) time off to attend healthcare appointments/treatments. The govt wants to force healthcare professionals to work around industry? This is a recipe for disaster; we already have an epidemic of stress-related conditions, and forcing everyone to seek medical attention outside of usual working hours will only exacerbate this problem. The current attack on GP hours will result in an overall drop in pt contacts as we try and maintain our sanity by quickly learning how to 'circumnavigate' the new impositions" – M Roche, London
"Have commented when PBC was first on the cards that this goverment intends to privatise or create a two-tier system in the NHS. It seems I am not the only one who thinks so" – Name and address supplied
"The government does not understand how general practice works, it ignores the evidence from the patient satisfaction survey that states they are already happy with access to services within primary care. Practices cannot offer extended hours without additional new funding, if this does not come down with the government proposals then core surgery hours, which currently suit the majority of our patients, will be dramatically affected to accommodate the minority of people who wish to see their GP out of normal surgery hours" – Gill Jones, West Yorkshire
"When 86% of the population has expressed satisfaction with GP services, what is the problem for the government? They are truly out of touch with the real needs of the majority of patients" – Dr S Kumar, Chingford, London
"If the government wants to force GPs to open their surgeries for longer hours, they need to make it easier for us to get staff to work longer or different hours. Employment law prevents us from unilaterally extending or changing working times of existing nursing and reception staff – have they thought about that?" – Name and address supplied
"On one hand we could have had improved care for osteoporosis and kidney disease (now doomed enhancements to the GP contract). On the other, open surgeries at night and weekends. What does the public really want? In my area, the cost of extra opening (and a fairly slim evening service at that) is around £1.5m. Whether this is paid for with new money or by cannibalising the daytime service is not the issue. What is at issue is that there are a hell of a lot of evidence-based health interventions that would save lives and reduce inequalities in health with that sort of money. Doubtless the "son of the manse" will get his way, but I suspect it will be a pyrrhic victory at best, with a disillusioned GP workforce walking away from a range of government reforms, including practice-based commissioning" – Name and address supplied
"Anyone who has worked a rota will understand that extending hours detracts from existing coverage, as the GPs will simply work less core hours to compensate. Ben Bradshaw's comments in today's media shows he lacks that understanding" – Chris Maude, Reading