I think that the government's attitude is going to be counterpproductive to say the least. GPs don't work 9-5, firstly the contracted working hours are 8:30-18:30 and secondly thats just the time available for patient appointments. The actual working hours are far more than this as the same government has now created an amazing amount of paperwork and tick-boxing work for GPs to do.

I not sure where this observation 'The doctor-patient relationship is not what it was' in this article is derived from. In a recent survery, done at cost of millions of pounds by the government, it was found that more than 80% of patients were satisfied with their GPs. Now thats a lot more than any of the politician's constituents.

There is nothing to be gained from this political posturing and I suggest that we be treated fairly for what we are ' self-employed professionals'.

Dr Gaurav Gupta, Broadstairs,

Perhaps we would have more time to spend with patients if we were not drowning in NHS bureaucracy, foisted on us by endless bodged reforms.
If Alan Johnson really is dim enough to pick a fight with a very fed-up group of Professionals trying hard to do their best despite endless meddling, then expect large swathes of the Home Counties to end up with the same access to NHS GPs as they have now have to NHS Dentists.

doug salmon, Birmingham, Uk

The British public have no idea how good they have got it.

Free 24 hour health care at the point of NEED and heavily subsidised (usually free) medications - try getting that in any other Western country. Yet they still whine and whinge.

If the press and government continually 'bash' GPs, it will only cause them to become more militant.

The only thing that is stopping the GPs from bringing the government to its knees is poor national representation.

Max Clifford, are you reading this?

B, Newcastle upon tyne, UK

I am often in the practice until well after 6:30 pm doing administration. On top of my 50+ hours a week I have to keep up to date. Is it really unreasonable to wish to spend the weekend with my family?

Michael , Esher, Surrey

You miss the point.
The days of patients seeing their own GP for night or weekend emergencies ended (for most) with the introduction of out of hours cooperatives more than a decade ago.
Prior to the new contract, groups of GPs ran the cooperatives verry effectively and efficiently themselves. They were forced to relinquish control (don't forget - most GPs didn't want the new contract) and the Government is now discovering the true cost of running them.
To provide a proper service, GPs need ready telephone access to hospital labs, imaging facilities and numerous hospital departments that just don't fully function outside 9am-5pm. Who's going to pay for them to extend their hours?
The media is endlessly and unquestioningly recycling inaccurate "facts" fed to it by Government sources (even the title of this piece is inaccurate - GPs cover between 8am and 6:30pm) and ignoring the reality that 84% of people are happy with opening hours just the way they are.

Mike Simmonds, Cardiff, UK

The article seems to confuse being on-call for emergencies at any hour of the day or night (any of us might need such a service) with longer opening hours so that it is easier for some people to see their own dr for routine appointments.

In my local area it is exactly the same organisation, same personnel,same triage nurses,same GP's who see patients at the out of hours centre after we "opted out" as were doing before! The point is that only now is the true cost of providing such a service - as opposed to what GPs were being given to provide it - now being felt across the country.

Given that the recent patient satisfaction survey reported that 84% patients were happy with their GPs opening hours (which is quite high when you stop to think about it) it seems difficult to reconcile why this seems to have such a high political priority now.

Mike Clayton, Preston, UK

Presumably as all of us GPs have had such a huge pay rise and such a wonderful improvement in our working conditions then clearly morale is at an all time high with new practices setting up , and vacancies being instantly replaced by eager newly qualified registrars. It might come as a surprise to your leader writer, but this does not seem to be the case. In fact the writers of such articles might want to consider whether they want GPs at all.
NHS mandarins have certainly considered this, and decided they don't - at least not in our current independent form. They have decided that we should be replaced by polyclinics - hospital like buildings providing primary care in an impersonal Tesco like fashion.
In order to achieve this aim they first need to break GPs. For this they have a two pronged strategy. Firstly the current system is neglected - with cuts, and a failure to fill vacancies. Secondly we have this concerted media campaign against us.

Dr Julian Chadwick, Tottenham, UK

I have run a slightly later surgery, to 6.30pm on Wednesday evenings for many years. Although this was set up to cater for people at work my impression is that it isn't particularly used as such. Sure enough when I checked tonight (Monday) the hour from 5.30 to 6.30pm was free. In the expensive Access Survey 9 of my patients from more than 500 surveyed wanted Saturday opening.

I don't begrudge losing several thousand pounds as the Government wanted to take over out of hours care. I'm still left with 8am to 6.30pm Monday to Friday plus the evening administration and education along with the occasional meeting. What I won't be doing anytime soon is extending my hours to satisfy another ill-considered political initiative for which there is dubious demand.

Mark Horner, Northumberland, UK

Most people would like to book an appointment with a doctor easily. Seeing a doctor outside office hours is less important than the ability to make an appointment easily and reliably in office hours.
This Labour Government had no idea what GPs did out of hours. They had no idea of its worth. They still have no idea what patients really want.
A parallel situation in hospitals is the headlong dash for "choice" when most patients want a local hospital of good quality. If I am burgled I phone my local police. I do not shop around to see which force has the best detection rates.
Lions led by donkeys.

John Carter, Chelmsford,

Doctors would happily work for the govt out-of-hours if they offered a good price as any good economist knows. The offered amount of £6000 in 2003 was clearly insufficient, so if the govt is interested in this, they had better offer a proper sum instead of threats.

James Teo, London,

GP surgeries are open from 8am to 6.30pm so to say GPs work 9-5 is not true. They are open for 52.5 hours a week.To ask them to open for longer without providing any resources is very unfair. GPs staff cost money and they do not want to work saturdays either. GPs work incredibly hard and deserve time at home with their families. Children need time with their parents.Certainly many women doctors will leave medicine and be lost to the public if they are forced between their families and their careers.

GPs have never seen routine patients on a saturday morning.They were only ever open for emergencies. What constituted an emergency was often a moot point.

MS, Dover, england

Please be just a little more investigative and current rather than plying the governments whining. Even the governments own £11m survey demonstrated (much to their embarassment) more than 88% of the population are happy with the hours available and the other 12% was divided equally between those wanting earlier starts, later starts and saturdays. What would you have us do, provide continuous 24Hr care again. Read the above comments about a tired doctor is a dangerous doctor....sounds fair to me. The PCTs have been charged with the responsibility (and given the finance) to provide appropriate 24 hr out of hours care. Surely the current GP bashing should be diverted to the PCTs to ask why are they not employing enough quality staff to cover out of hours and weekends, if there is a problem with the current provision.
Please stop acting like a government mouthpiece, you are surely worth more than that!

David - , Sunderland, Tyne and Wear

"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."

Because working evenings, nights and weekends is just so family friendly, social life encouraging and down right fun.

GPs have lives, too, you know.

MK, Nottingham, UK

We should accelerate the move away from GP principals towards salaried GPs, accountable to the Primary Care Trust.

A lot more routine work could be devolved to suitably trained nurses, fewer GPs will be necessary. I think the days of the broadly independent GP within the NHS are numbered.

I think the opt out from emergency on call has alienated many patients.

There used to be too many hospital consultants who took advantage of the freedoms given to them, this has largely been addressed.

I would support the government, if it chooses now to take on the GPs.

As an NHS employee I have had contact with doctors both in and outside hospital. In my experience there have not been many GPs of a calibre comparable to the average hospital consultant. .

Too many GPs do not justify their salaries.

john smith, london,

I think it is a good idea for GP's to look after their own patients as far as possible. If 9 am to 9pm cover is provided by the patient's own GP it will reduce the referrals to secondary care as most patients are likely to be known to their own doctors. Saturday and even Sunday opening should be encouraged; even Marks and Spencers open on a Sunday! The way to go about this is to increase the number of doctors in General Practice by a third so each doctor continues to do what they currently do but there will be more of them. We will be producing sufficient number of home grown doctors. Delivery of service in GP Surgeries must also be looked at so that a session is used to full capacity where needed. Waiting times more than 24 hours to see a GP MUST be a thing of the past.

S Ravi, Blackpool, Lancs

I agree with JK, ridiculous. GP's are the current scapegoats.
86% of patients satisfied, but extended hours required? What other business (the Government wants GPs to run Practices as businesses) would open longer (with associated staffing and overhead costs) for the same revenue - none. Let GP Practices charge for out of hour appointments, may assist but would patients want to pay doctor and staff costs?

Appointments - this is due to Government Targets and inconsiderate patients. GPs must provide at least 5 appointments per patient per year. Many patients that attend double that per month under the "it's my right" mantra that is prevalent today. This would become worse if longer hours were required.

Open for "a few hours" - Patient seeing perhaps, but each GP must complete vast amounts of paperwork. Each GP works for a similar amount of time per day to cope - unnoticed and unappreciated work.

Preconceptions of "an easy life" like Doctors on BBC1 are not realit

Neil, Birmingham, England

The government negotiated with GPs that they could opt to cover their patients round the clock, or not to and accept a lesser payment. The goverment's costing of providing an out of hours service was wildly inaccurate, evidently because they did not believe the GPs when they told them that this service actually did mean a lot of work!
No-one in their right mind would have done other than opt out as the monetary difference was a pittance, based on the government's miscalculations.
The true cost of a twentyfour hour service has now become apparent. GPs are as hard working as any other professionals, provide excellent services and are not overpaid.
(I am a hospital doctor.)

W J Johnston, Muscat, Oman

The modern GP is not only to see patients he is required to maintain his level of education, knowledge and comply wtih a vast amount of government bureaucracy that consumes as much time as clinical work . Filling in the forms enables them to be paid. and has improved the quality of care in the UK..Most GPS work 50-60 hrs a week, the recommendation for safe practice is 48. Evening ,weekend surgeries and out of hours work would stretch most doctors to the limit . At the end of the day of the day we require doctors who are fit and safe to practice. Johnson has forgotten that tired doctors are dangerous doctors. The people of Britain deserve better than Johnson would offer than them.

John Rodriguez, Bradford, United Kingdom

I'm afraid that capacity will never be able to meet demand. I've worked in the NHS for over 20 years and regardless of the multiple reconfigurations, if the service is free at the point of delivery, there will always be doctor shopping at walk-in centres, NHS direct, A&E as well as GP surgeries.

Dr Asaf Bashir, London, UK

GPs cannot suddenly open 24 hours a day like Tesco, it takes about nine years training to get to be a GP so the workforce is just not available . A full time GP cannot be expected to work evenings and weekends as well as working full days. I am a GP regularly working from 8 am to 6:30 pm and have no interest in working any more hours than this. If we are made to work in the evenings and weekends the surgeries will have to close during the week . We would still have the same regulars attending week in week out but at different times !

Dr Ben Williams, Manchester,

I think doctors work hard enough. I also think politicians are just saying things they think people want to hear, knowing it's an impossibility to carry out.
I would rather have a doctor that knew what they where doing then somebody that was so over worked that they might wrongly prescribe or overlook an important symptom of a serious illness.
Hobbit

sheila, Robertsbridge, East Sussex

When the BMA had negotiated the hew GP contract there were two aspects which led a majority of GPs to vote in favour of a new contract. The first was the opportunity to give up out of hours responsibility for a sum of £6000 and redefine hours of responsibility for patient care from 24/7 to 8am to 6.30pm weekdays. The second was an enhanced deal on pensionable earnings. This government is now going back on a contract it has signed with the profession by trying to force longer opening hours and capping maximum pension benefits. They cannot be trusted to even honour contractual assurances they entered into themselves in free negotiations.
No wonder GPs rank amongst the most trusted professions and politicians are pretty much on the bottom of the list just below estate agents.

Ulrich Pfeiffer, Liverpool, UK

Appointing a surgeon to redesign general practice is like having a plumber rewiring your electrics. Why this ongoing confusion of out of hours emergency cover and routine in hours care? The new contract has not changed GP surgery opening times for routine care at all. It only redefined the hours of responsibility for patient care from 24/7 to 8am to 6.30pm weekdays only. Most GP surgeries ran Saturday morning surgeries for emergencies simply because it was more efficient to see the sniffles and earaches themselves than paying a fortune to the local commercial out of hours service, also known as Dial-a-Doc. Given the opportunity to opt out of 24 hour responsibility at a price of £6000 per year most GPs jumped at it, the rest were pushed by the imposition of unworkable standards for availability and response times. The incontrovertible fact that PCTs made a complete hash of commissioning out of hours care cannot be blamed on GPs.

GPs deserve their pay, because they are worth it

Ulrich Pfeiffer, Liverpool, UK

This whole situation has been brought about because the government did not value or heed GPs in the first place: we provided cheap and highly effective 24 hour care. Unfortunately, but not surprisingly, being available 24 hours a day for any whim is highly stressful. Until recently there was a GP recruitment crisis. Young doctors chose careers in which on call reduces over time. GPs had to continue at the first line of on call until retirement. The government were keen to take over out of hours because they wanted to reduce GPs' power and introduce cheaper systems. Now they realise what we already knew; out of hours health care is a nightmare, a neverending black hole of demand. They realise now that GPs were actually cheap and effective. Rather than admitting that they were mistaken, and acknowledging the excellent and valuable work GPs do, that 83% patients are happy with, which costs less money than any other system, they are trying to bully us into taking out of hours back.

sarah, york, york

How many hours would you like me to work, 80,90,120,130. I have no more to give. My life was given back to me in 2004. If there is any attempt to reverse this, then I think it will be time for me to emigrate.

Currently we are open from 8am to 6:30pm. When do you suggest that I do the work I currently do in the evenings such as practice admin, education, meetings with the PCT about PBC or whatever the latest Government fad is? Perhaps we could arrange that for 11pm -2am after the late evening surgery, so home for about 3am but must be up at 5am for the commuter surgery at 7am. Whoops forgot to eat or sleep.

Strangely enough doctors are people too and have lives outside work.

John, Notts, UK at present

Longer appointments ? Longer Hours ? Delighted to oblige; it's called Private medicine.

doug salmon, Birmingham, Uk

Could I also have my bank/solicitor/dentist open for extended hours as I can never get an appointment in the working day.

Richard , Edinburgh, Scotland

Clearly the BMA only quizzes those who manage to see their GP during the week ...the rest of the population who work struggle to see their GP, let alone rate the service.
Working very long hours myself, I have found that routine checkups just keep being postponed....as it means having to take time off. Surely this must cost the taxpayer more in the long run, as those routine checkups are suppposed to identify problems before they become really serious.
I personally am not opposed to paying for a GP visit....plenty of other countries charge. I can afford it so I am willing to pay a nominal amount. Obviously not everyone is in this position, but those that are - why not moot the debate?...or is user-pays a dirty word in the UK??
New Zealand has a user-pays system (obviously free for the very young and the retired), but GP surgeries are run like businesses - open on Saturdays, you always get an appointment the same day and the service is excellent.

Rebecca, London,

Oh Dear, how quickly we forget the founding values
"It is incumbenet on any employer in a civilised society to allow its employees adequate time off work for their health needs"
forms the preamble to the NHS Act 1947.
Yes I can shop at Tesco Supermarkets at 2-00am but do not because the fresh fish counter delicatesen and pharmacy are closed, the fruit and vegetable section is devoid of any produce except a value bag of potatoes and a shrivelled broccoli head. Extending the GP surgery opening without the commensurate change in Primary Care Trust support staff to validate patient registration details, consultant secreterial staff on the local hospitals to answer the queries about clinic results cancelled appointments, Laboratory and Radiological imaging results would produce a very second rate service.
The NHS pays enhanced rates for unsocial hours. How do you justify the fact the same outcome costs the taxpayer more at night! See your Doctor in the day and pay less tax

Andrew Mimnagh, Liverpool,

The reason why the pay settlement you criticise was made was because there were areas of the country where there just weren't enough GPs, market forces and all that. GPs used to make up for poor salaries compared to their potential earnings elsewhere in non-financial terms, such as the respect and deference you mention as well as a relatively high degree of independence in performing their duties. Governments decided they were no longer prepared to pay in non-financial terms, so GPs did the economic thing and said, in that case we'll have the cash. Basically, you're now saying you want an out-of-hours service on the cheap - tough! If you're not prepared to pay the economic cost of attending a GP surgery during the week, i) do you really need to see your GP and ii) how much extra are you (or your employer) willing to pay to do so out of hours? Welcome to market economics in primary healthcare. You want an out-of-hours service, you pay extra for it.

E Burgess, Slough,

In Australia the system is a bit different - a doctor gets paid based on the consultation and what it is for. Not salaried. And there is no permanent link between a doctor and a patient - so you can go to another doctor if your usual doctor doesnt have time for you. Works wonderfully well!

Nimmi, Bristol, UK

An overworked tired doctor is a dangerous doctor. Therefore if a doctor works out of hours he is not going to be available for the morning surgery. If he is on call through the night he will not be available or fit to practise the following day. Doctors must be fit and safe.

John Rodriguez, Bradford, United Kingdom

Just how many hours in a week do people feel is sensible or reasonable for a GP to work?

Giles Hammersley, Paignton,

This is ridiculous...one can hardly aportion blame to GPs themselves that patients cannot get appointments or that consultations are brief. These grievances are all due to the system the Department of Health imposes on us. Doctors are often frustrated about the very same things.

JK, Birmingham,

I wonder what some of your more astute commentators would make of your prescription given the evidence.

A large-scale patient survey involving over 6 million people rejected the idea of extended GP opening by 93%. It's possible that people living in the real world (as opposed to politicians and newspaper editors) recognise that GP's work hard already and that forcing them to extend hours to satisfy the whims of a few will leave GP's and nurses fatigued, offering a substandard service to everyone.

Prior to the new contract, there was an upper limit on the number of patients per GP (3200). HMG could have improved patient care by reducing that limit, whilst offering GP's a modest pay increase only. This would have reduced workload, led to more and longer appointments, and a more personal service.

Instead, HMG abolished the limit. So instead we will get a substandard impersonal service delivered by profit-focussed companies using a cheaper workforce.

onion, London, UK

"That GPs are working about seven hours fewer than they did in 1993 should not be a particular cause for celebration."

Seven hours per what? per day, per week, per month.

Another sensationalist article with no basis in fact. Are you the Daily Mail ?

Jon, Plymouth,

OOH service provision must work both ways. We as patients have a responsibility to our fellow patients and to the health professionals to act appropriately. As many as 40% of GP appointment slots are wasted by patients not attending, meaning that others who need those appointments cant get access to a GP until its OOH, ie. pressured daytime appointments wasted with further stress on OOH services. Likewise, if it can wait until morning, it should. Do stubbed toes, sore throats for 7 days, really need to be seen OOH? We should also ensure we have our repeat prescriptions filled in enough time that we dont run out of our insulin or inhalers or other vital drugs and need to attend A&E or GP OOH.

There has been a constant barrage of unwarranted spin against health professionals and GPs in particular. Time to ignore the spin"doctors" and listen to the real doctors.

Who cares for those who care for us?

Neil, Glasgow,

As GPs are supposedly independent contractors then, contrary, to what you say above, they do not have employment contracts for the government to tear up "at will" or otherwise. Contratcs with suppliers are regularly renegotiated in industry.

The system is highly unsatisfactory, but while it exists, the government should use its monopsony power to get the best possible deal for the taxpayer - the interests of the producers should carry no weight whatsoever.

The BMA (a trade union, remember) will scream and say that no-one will want to be GP as a result, but there only ever was a shortage of GPs because of the restrictions on the number of medical students and of the control of the royal colleges over entry to specialisms (of which GPs are one). Well- qualified students are literally lining up to train as medics as the huge surplus of applicants over places shows.

HJ, Reading, UK

Do GP's travel by train or fly on holidays outside normal business hours? Or do they use Internet services, shop, view television or read newspapers or visit the pub or use a multide of other services outside of business hours? The provision of almost all services depend on and include the professional expertise of people. The BMA shoud not compare GP's working hours with accountants simply because accountants do not generally need to work outside normal business hours. More logical comparisons should be made with all other health workers including private service providers and supermarket chemisits and emergency health service professionals such as paramedics. GP's have already thrown away their "special staus" by opting out of the responsibility for total patient care by restricting their hours of access. There is a dire need for surgeries to open at evenings and at weekends and unless GP's meet that need it may not be long before the status of GP's is much less than accountants.

Paul Horan, Stockport, England

Patients are now registered with the PCT and NOT the GP. The PCT employs 'Contractors' (the words of the GP Contract) - some are Self-employed GPS, others are Salaried GPs.

The Flowers Report skewed Medicine into a predominantly female profession; women working part-time wanting a "work-life balance" to raise children with no interest in working through the night on call and feeding their babies at the same time.

On call can be dangerous, violent, and is certainly unsocial. Why do the British have this fetish that no healthcare system in any G-8 country has copied ?

TomTom, Leeds, England

Why do people confuse opting out of out of hours care, with providing routine appointments in evenings and weekends? Since the NHS has been around (1948), most GPs have never provided appointments in the evenings or at weekends, and the reason they have opted out of providing out of hours care is because it was a huge drain on them. They actually sacrifice seceral thousand pounds in salary each year not to do this, that's how much it means. Just because the government then contracts out these services to the lowest bidder who provide a no frills, threadbare service, isn't the GPs fault. Before the new contract junior Drs were being offered up to £12,000 lump sums to train as GPs because it was seen as such an unattractive job hardly anyone was going into it. Now it's practically the most competitive specialty to get into and there are hundreds of fully qualified GPs without jobs forced to do locum work because there's no funding for the extra jobs that are required.

Matt, London, UK

I am a single-handed GP. I do all my own on-call. In emergency I am freely available to my patients and the many tourists I see, 7 days a week, 24 hours a day. I gave up Saturday morning surgeries 2 years ago and I will NEVER, under any circumstances, do them again. I have records going back over 24 years. I can tell you who I saw on Saturday morning, why, for any given Saturday in that time period. Routine, as opposed to Emergency, care is simply not necessary at weekends. The populace may have been encouraged to want it for political reasons but they don't NEED it. 87% agree with this view. I also have records to delineate and defend the gradual reduction of my evening hours to bring them within a 5.30pm deadline once it became apparent that my staff and I hanging around after this time benefited very, very few.
I provide a Public Service not a Public Convenience. I will continue to do so as I see fit. No government or Consultant Surgeon is going to change that.

Maureen Douglas, Argyll, Scotland