I have felt for years that local doctors surgeries are failing to meet the needs of their community. What particularly galled me was the availability of well man clinics in the evenings, but well woman clinics are only available mid-afternoon. This is a commuter town. Hundreds of people catch trains to London at 7.30 in the morning, not returning until 7pm. To visit a doctor means taking a half day off work. I know from experience that City bosses are very intolerant of such absences. The new appointment arrangements that require patients to call the surgery on the day they need an appointment are impossible for commuters. If you call the surgery when it opens (8.30 if you're lucky) and wait in the queueing system you're already at least 90 minutes late for work if you can't get an appointment that day. It is time that doctors took a look at how the world works and spread their surgery hours so that patients don't have to take time off work to visit them. Gillian Kirk, Berkhamstead
Yes, as a full time GP I think the idea that patients will see a GP whenever they want is great. How this will be achieved using the current work force remains to be seen; it may well be that doctors from outside of the UK will need to be recruited, or locums or doctors working part time will cover these early or late hours and the "weekends". Current doctors are already working to the maximum, so how can they do more ? It is like asking a lorry driver who drives 18 hours a day, to drive 23 hours instead. He needs rest, otherwise he will be driving 23 hours a day, and only one hour to sleep. Simple. Kwong Man, Edgware
I support these proposals and any other proposal to improve efficiency in the NHS. The BMA describes anything that results in a lessening of their seemingly God-given authority as "irresponsible and dangerous". This is simply code for 'if others do our job we will lose our closed shop and our fat salaries'. When this or some other newspaper recently reported that perhaps 30,000 patients were being killed by NHS accidents every year I do not recall a similar outcry from the BMA. I wonder why? It is past time that the British public woke up to the scam that is the BMA. Derek Sinclair, Dundee
As a GP providing Out of hours health cover we are already doing what is being proposed. At the moment we are providing only emergency cover. The difficulty in providing "regular health MOTs" is due to the inaccessibility to the patients health record. If this is corrected either by interlinking the computer systems or by providing health swipe cards the out of hours service will become even more effective. It will also be more accessible to fit in routine appointments for patients with busy lifestyles. Bazurulla Khan, Worcester
It's about time that GPs provided a more convenient service for the workers who are paying for them. I'm tired of having to take hours off work every time I need to see my GP because he works 9.00 to 17.00 near where I live and I work 9.00 to 17.30 in central London forty five minutes away. Despite this, it's not possible to register with a GP near to work. What a waste of workers' time - it's time somebody saw sense. Anna Smith, London
What a wonderful idea. Nurses and pharmacists to prescribe any medicine. We should have air stewardesses being allowed to fly jumbos and legal clerks representing us in court, not to mention builders labourers designing bridges and hotels. What fatuous people run the country today. When lawyers, accountants and politicians are available free of charge at weekends and through the night for routine work, then so should GPs be. The standard of NHS care is rapidly reaching Third World status without causing the few remaining British-trained doctors to leave the already sinking ship. Bill Bartholomew, Melbourne
Access to GPs is a problem in many places. It would really help if they opened two evenings a week and Saturday am as it is so difficult to get time off. The system whereby you have to phone on a particular day to get an appointment is appalling: if you book the day as annual leave in advance you can then find you haven't got an appointment. Aubrey Wilson, Hinckley
As a GP for twenty years I know that most consultations in general practice are not emergencies requiring immediate access but involve chronic conditions. In such consultations, what patients value most is not instant or 'out of hours' access but continuity of care. The depressed or anxious patient in particular does not want to go through the story all over again but values seeing the same doctor each time who understands their background and can provide ongoing support. If increased access means decreased continuity, it may not lead to better treatment for the majority of ongoing illness. Trevor Stammers, Epsom
I agree with the proposed changes. My local surgery used to open until 8pm and on saturday mornings until last year. Now if I need to see a doctor for any reason I have to take a day off of work to do so. Being an asthmatic means that I loose a days holiday to the doctor every three months for a review of my medication, or if one of my children are off ill. The only option we have at present is to travel on two buses (which only run to 11pm) to a centre in Hillingdon as there is no night time call out service at our surgery. Jacky Kershaw, Harefield
One of the strengths of the NHS is that one doctor - the GP - has a complete picture of the healthcare needs of the patient over a long period of time. These proposals, such as dual GP registration, risk fragmenting this co-ordinated and continuing care, to the detriment of patients. Also, there is no evidence that regular health “MoTs” are of any value, so why require GPs to provide them? John Clark, Wirral
As someone who works full-time, and spends close to an hour commuting each direction, I simply don't have time to head back to see my GP during the day. A single appointment therefore takes out at least half a day of work - time which I simply can't afford. Evenings and weekends are the only time I have. Dominic Graham de Montrose, London
Well frankly, its about time they worked for the money they earn. I agree to the proposed changes as I trade in The City and it's a hell of a job getting time to get to the Doctors, even its just a routine health check. Name and address withheld
It's a great idea. No objection in principle to the proposal. GPs could re jig their patterns of working if needs be. I wonder whether Miss Hewitt is really willing to pay for GPs to work later and the extra costs associated with running surgeries securely at night. The later opening being demanded could be funded by charging patients directly for extra convenience. Peter Davies, Halifax
As I work about 20 miles from my GP, it is far more convenient if I can see him (or her) in the evenings or weekends. If I see the GP during working hours, I either have to take a day off or lose several hours of time. I am not bothered whether I see my registered GP or not, they all have the same notes to look at, but it is nice if you can see the same one during a course of treatment. David Leslie, Crieff
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