The Prime Minister’s apparent determination to renegotiate GP contracts has provoked a predictably angry outburst from the British Medical Association (BMA). The scene is set for a fierce battle, for both sides have legitimate grievances. Doctors protest that Labour is going back on its decision, made only three years ago, to let them choose whether or not to be on call during evenings and weekends. They also fear, with some justification, that ministers hope to make them the scapegoat for all NHS ills. Meanwhile, ministers know that the large number of doctors opting out has been both extremely costly, and detrimental to patient care. The NHS has been left in the ludicrous position of paying more for less. While this is a mess entirely of the Government's own making, it is one that must be resolved.

Family doctors are highly trained people doing an important and responsible job. They should be properly paid. But the deal implemented in 2004 involved paying GPs higher salaries while shortening their hours. While it offered doctors the chance to earn more money by carrying out minor operations and other procedures, relieving the burden on hospitals, it also broke the long-held understanding that doctors should be available to patients in times of acute need. The eagerness with which almost 90 per cent of doctors have thrown off their out-of-hours obligations has made them look more like salaried bureaucrats than the self-employed professionals they claim to be. That GPs are working about seven hours fewer than they did in 1993 should not be a particular cause for celebration.

Sickness does not always strike during normal working hours. So locum supply has become a flourishing industry. Commercial companies and GP cooperatives have emerged and some are even flying in doctors from the Continent. The provision of alternative cover in the first year of the new contract cost £70 million more than forecast, according to the National Audit Office. Nevertheless, some parts of the country still appear to have insufficient cover.

The doctor-patient relationship is not what it was. That is partly because of the general decline in deference, and the rise of patients armed with doit-yourself, downloaded, diagnoses. But many patients are also infuriated by the feeling that their doctors have abandoned them. They are upset at having to call again and again to make an appointment – a situation exacerbated by government targets on appointments. And they are irritated by the brevity of those appointments (it is hard for a physician to take a “holistic” view, patients feel, in less than ten minutes).

Members of the BMA need to get their stethoscopes out and listen more closely to the nation’s heart. Their claim that patients do not want GP surgeries to open for longer does not ring true. Many surgeries open for only a few hours in the morning and a few in the afternoon, all within what for most people are their working hours. The BMA’s protest that “no other professional provides a weekend service” also sounds thin.

The BMA would be on stronger ground if it argued that talented young people could be put off medicine if they thought that governments can tear up employment contracts at will. Ministers must handle this issue very delicately. There is no reason for government to force surgeries to open on Saturdays, for example: it could be cheaper if doctors opened for longer hours in the week. But however the pill is sugared, one thing is clear: the NHS must get more out of its GPs.