Picking a row with family doctors is a high-risk strategy. Poll after poll shows that doctors are far more trusted than ministers.

Yet somehow the Government has positioned itself as the aggrieved party after a contract – which it agreed and signed – turned out to offer GPs more than it had bargained for.

Doctors’ incomes rose at the very same time as they shed responsibility for out-of-hours services, prompting headlines about GPs being paid more for doing less.

Gordon Brown’s attempt to cast the GPs as the guilty party has been bitterly resented, especially as they have produced almost all the improvements in quality that the new contract aimed to achieve.

That, indeed, is the problem. A contract that rewarded GPs for service provision with “quality points” that each carried extra pounds of income found them all-too-willing to oblige. They scored so highly that they earned a lot more money, for which they were duly castigated by ministers.

The contract can hardly now be rewritten. It could be torn up: there is a precedent for that, but it goes back to the days of the Conservatives, when Kenneth Clarke was in charge, so is hardly likely to appeal to Mr Brown.

The alternative, if the Government really wants to square up to the GPs, is to make their lives a little less secure by the threat of competition. Private companies seeking to run GP surgeries can be made to sign up to the Saturday surgeries that the Prime Minister so ardently desires. GPs aiming to compete would have little choice but to do the same.

Private companies might also be willing to participate fully in practice-based commissioning, the Health Department’s plan to make GP practices the place where NHS services are planned and ordered. This is rather like the Conservatives’ fundholding policy, but lacks enough incentives to persuade GPs to join.

Despite ministers’ claims that GPs are flocking to join, the scheme is in trouble. Experts believe that about 15 per cent of GPs are truly committed, the rest having done little more than pick up a bonus for thinking about it.

Persuading GPs to go in for practice-based commissioning may prove even harder than making them work on Saturdays. Many might not mind a Saturday shift, although the corollary would probably be a half-day off in midweek. But they question whether the idea is really so clever.

The typical GP’s waiting-room is not filled with people dragged from their desk or workbench, but with the retired, the elderly, the chronically sick, and mothers with young children. For them, Saturday has no magic appeal.

Among those who do work, occupa-tional-health schemes or walk-in centres can provide a medical service during working hours. Indeed, the Government’s miscalculation during the negotiation of the GP contract was that walk-in centres and NHS Direct could do the out-of-hours job better and more cheaply than GPs. They could not.

What is now proposed is not a return to GPs providing out-of-hours care, but ordinary care in extended hours. The distinction is important. Out-of-hours care was always an emergency service for urgent cases. What is in Mr Brown’s mind is ordinary care, provided at a different time.

One suggestion is that access become part of the quality framework, so that GPs providing it would be rewarded financially. Perforce, that would mean extra money, or points being removed from some other quality objective. The BMA would be unlikely to agree, and in any case the feeling is that GPs have upped their incomes enough not to be tempted by a few quality points. Hence the alternative: threatening them with competition.

Some patients would, of course find it convenient to be able to arrange appointments with the GP on a Saturday or in the evening. Whether such services can be provided economically when the NHS budget is ceasing to grow at a giddy rate is uncertain. On its record, the Government cannot be trusted to do the calculation, anyway.

What it cannot get away with is claiming that it wants to go back to something that has recently been lost. Saturday opening may or may not be a desirable objective, but it has nothing to do with the 2004 GPs’ contract.

Wealth check

GPs in England earned, on average, £103,000 a year in 2004-05, the first full year of the new contract. Earnings in Scotland, Wales and Northern Ireland are lower, reducing the UK average to just over £100,000

Since 1999-2000, GPs’ pay has approximately doubled, from £52,000 a year

In 2006-07, full-time GPs worked 44.4 hours a week, on average. This was almost exactly the same as in 1992-93

The number of patients per GP, and the number of consultations, have both declined. Home visits have almost disappeared. But the average length of a consultation has increased, from 8.4 minutes in 1992-93 to 11.7 minutes in 2006-07

Source: Times database

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