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The doctor will see you now

As opening hours are extended and alternative healthcare providers enter the general practice market, it will be fascinating to witness a new kind of care

Lynn Young
Primary Healthcare Adviser for the RCN

War has been declared on general practice over the matter of extending the opening hours. The Right Honourable Alan Johnson, Secretary of State for Health, has gone over the BMA's head and written directly to all GPs currently working in the UK. Prime Minister Brown has loudly backed the rights of working people to be able to access their GP outside their working hours. Which all means that many a practice will soon have to open its doors in the evenings and on a Saturday morning.

The interesting thing about this argument between the government and GPs is not the issue of extended hours, but the matter of who is actually in charge of general practice.

Since 1948 - the birth of the NHS - GPs have for the main part been self-employed, although in recent years the number of salaried GPs has relatively dramatically increased, for a number of reasons - not all newly qualified GPs wish to manage the business of general practice but simply want to concentrate their energy on practising the art and science of medicine; approximately 60% of new GPs are female and wish to work part-time while raising a family; and on top of this we have an increasing number of nurse and practice manager partners, who are helping to shift the historical culture in primary care of male GP domination.

GPs have always valued their independence and have had the freedom to practise and manage their work with a level of autonomy that many an NHS-employed clinician has envied.
But while GPs have in the past been described by some as self-employed businessmen and women, they are paid via the public purse, not from individuals choosing to pay the GP of their choice a consultation fee.

2008 is an important year in the history of the NHS, as we are about to celebrate 60 fine years, during which most of us have happily used its healthcare and been content with its quality and competence. Sometimes the care could have been better, on occasions it has been abysmal, but it is quite usual for lives to be saved, simply on account of the care being inspirational. The NHS has survived and current leaders of the Labour and Conservative Parties have publicly stated that healthcare is to continue being state-funded and free at the point of need.

Which brings me back to our colleagues, the GPs. Back in 2004 a contract was agreed and signed by both the BMA and the NHS Confederation, which completed this work on behalf of the government. But now the government is calling for the contract to be amended to extend opening hours. In the past when there has been a head-to-head between GPs and the government, the call has been made for GPs to resign en masse. But why would they do this now, at a time when general practice has never been so richly rewarded?

Also, policywise, there has recently been a dramatic move. Alternative providers are now being encouraged to enter the traditional general practice market. United Health has won contracts in Derby and North London. Virgin Healthcare is bidding for business in the belief that its kitemark of quality will win many a contract in areas where local people are underserved by general practice.

The government intention is to improve and expand general practice, particularly in relatively socially deprived areas. It will be fascinating to witness a new kind of practice, open all hours and ably caring for its employed and unemployed population. But this time such a practice may have the quality mark of United Health or Virgin Health, rather than a number of named GPs.

Only time will tell. The current skirmish between the BMA and the government has now been settled and we can enjoy peace again. In my opinion though, it is the quality of care that matters, not the particular logo or brand.

Your comments: (Terms and conditions apply)

"Is nothing in the NHS new? At this rate GPs will be living over the surgery, employing their partners as receptionists and sending district out on bicycles. I will be interested to see what has happened to the millions of NHS pounds spent on alternative OOH care, where do walk-in centres, NHS Direct, urgent vare nurses et al, fit in to this plan? I may have a jaundiced view of politics but this smacks of government who are winning the power struggle with 'independant contractor' GPs." - Name and address supplied

"Agree that GPs should offer extra hours, when patients call OOH, NHS direct, they have not got any previous medical hx, Lets hope this does not increase the work load of the Practice Nurses, who are already stretched to the limit, with reaching QOF points, for the Drs, to have there bonuses. Private care providers would cause more health problems, risks to our patients, so lets put the Care back into the health service, and
not concern ourselves with targets and figures." - Name and address supplied