Whether or not it is necessary for GP's to provide more cover at weekends and evenings should be a matter fo discussion between patients and doctors providing services; not a matter to be dealt with by issuing ultimatums.

liza piney, cockenzie, scotland

Whether of not it is necessary for GP's to provide more cover at weekends and evenings should be a matter fo discussion between patients and doctors providing services; not a matter to be dealt with by issuing ultimatums.

liza piney, cockenzie, scotland

Do any of the GPs writing actually read the news about the state of the NHS? It may come as a bit of a shock, but lots of the middle class, educated, reasonably well off public don't think the service you provide is actually very good. The proportion of tax that I pay for a service which might have impressed my equivalent in the early 1950s is no longer good enough and I object to having to pay a second time, privately, to get a level of customer service that I should get from the NHS. I wouldn't mind trying a US style system. That way I wouldn't pay twice for the same service and those drs who aren't very good (believe it or not, there are quite a few of you) would be starved out of practice. As I write there are 193 responses to this item, quite a few from drs - but I haven't spotted a single one which demonstrates any critical self-awareness. Perhaps a bit less overblown arrogance? GPs' attitudes reflect those of old Soviet monopoly providers - they risk going the same way.

George, Brighton, UK

There are a couple of issues to remember. It was only 4-5 years ago that doctors were given a golden hello payment to become GPs as not enough people wanted to do it. the reasons cited were pay, long hours and being on call very often.

The pay increase and better conditions mean that more medical students want to be GPs. It is important to note the disparity between hospital physicians who work longer hours, work noghts, have a much longer training scheme and get less pay.
the solution is to train gps better and longer and then they definitely will deserve their pay. The question of out of hours service is interesting. in reality if you are sick out of hours you probably need a hospital assessment. There is a strong argument for weekend appointments and an increase incentive for gps to do home visits to immobile adults /nursing homes.

Dr Jonathan Myers, london,

Kathy, Stoke. I'm only talking about NHS pay. As for ' expected to deal with anything and everything ', with what level of competence? My solution would be to dispense with general practice as anochronistic and totally outdated. I don't believe that any profession based around complex skills can any longer support general practitioners. To everyone else who talks about GPs as business people - you're joking?! Competition has to involve the real prospect of failure. Law firms competing for public sector contracts may be up against a long list in double figures and if they make the shortlist, perhaps 5 other firms. Only one will succeed. The rest have spent money and significant time putting together a pitch - all for nothing! The best thing the government can do is to keep expanding medical school places and encourage doctors from other EU states to perfect their English. Only when we have a significant oversupply of drs in genuine competition will we get the best value & care.

Graham, Oxford, UK

The GP is but one personality in modern primary health care . Does the public wish to pay for support staff, practice nurses, hospital pathology laboratory support, physiotherapy, community mental health teams etc etc etc to be funded for extended hours. Somehow the GP is always the figure of attack because of earnings.

The public should be aware when they see a modern GP they are seeing a very highly qualified professional. Brightest and best to get into medicine. Then from medical student to fully qualified GP 10 plus years. They are self employed professionals running complex businesses. Why are earnings such an issue?? Other self employed professionals running businessed earning purely public sector contracts (from solicitors to actuaries) earn far more. What is the problem, does the public really want cheap and cheerfull health on the supermarke model?? I think not. The professionalism of GPs is refelected in survey after survey of satisfied patients.

Sarah Galbraith, basingstoke, uk

Graham, Oxford
I am fed up hearing about doctor's salary! Surely these people should be commended for going into a job that must be incredibly frustrating as they are not able to get on with looking after patients, they must constantly defend themselves against the constant criticism in the media and goal post moving by the government. When it is all privatised and doctors are probably earning a lot less, will you question the profits being made by the company running your health centre? The GPs making that kind of money are running a business, they are partners not just GPs. The government, as far as I understand completely underestimated the work done by GP partners when they negotiated pay - is this the fault of the GPs? I think its time we stopped doctor bashing and focused on the real issue here - HMG not coming out and saying we made a mistake thinking we could run out of hours services better and cheaper

Susan, Manchester,

I would like to ask Graham from Oxford where on earth he gets the idea that a GP earns more than a heart specialist, in my experience and I am a GP I earn way less than half what a heart specialist does and work longer hours. I am expected to deal with anything and everything that walks into my surgery not just hearts and get nothing but insulting crtisism from the press. Maybe people should look at the health care system in the USA because if Labour gets its way thats just where we are heading.

Kathy, Stoke-on-Trent, Staffordshire

gail, middlesborough. This seems to be a more generous and polite way of saying the same thing as some earlier commentators regarding the 'value' of general practice. Taking it as read that you are correct - why on earth would the average tax payer consider those provding such gate keeping an associated services to be worth the sums that the average GP is alleged to be raking in? The GP who decides that my chest pain may be more than just indigestion and calls an ambulance to take me to hospital could easily be earning more from the NHS than the heart specialist who diagnoses the detailed nature of the condition and then takens the appropriate steps to save my life. Surely a serious imbalance here in pay terms - and I don't mean that the specialist should be paid even more!

Graham, Oxford, UK

it seems that a lot of people don't understand the role of the gp, they are not here to provide 24 hr emergency care, we are past the days when gps treated heart attacks in living rooms thankfully. medical advances mean that hospital care for emergencies makes a real difference in survival, it would be unsafe for gps to manage these at home. What gps do is provide health promotion and chronic disease management, spot early warnings of serious disease, treat mental health, child health, sexual health, counselling, social service liason, benefits advice, minor illness advice....Why can this not be dealt with between 8 and 6? ( not 9 till 5 as people insist on saying) .Out of hours is totally different. That should be about managing minor ilness safely and directing appropriately to secondary care.

gail, middlesborough,

Leslie, Midlands. I expect that the debate about the amount GPs take home on average could rumble on indefinitely - not to mention the debate about what some of the higher earners get, given that it is an 'average'. Your comment 'become income not a patient' is an interesting one as it clearly strikes at what many value about the current system. However, it also strikes at what may well have led to much anger from outside of the profession. The hallmark of a good doctor has always been seen to be a strong element of selflessness and social awareness. In essence, the BMA damaged this by accepting/pushing for such a high settlement when other public sector workers were and are (prison officers today) being squeezed so hard. The government may have messed up, but the government has no money of its own - it all belongs to the taxpayer. Sometimes taking advantage of another's mistake can have negative consequences - I think that the BMA and GPs may be learning this lesson the hard way.

George, Brighton, UK

That's right! Go for privately run surgeries.
You know what? You the tax payer will pay more. The people who run these surgeries will earn much more and you may get out of hours access, but you'll see a a doctor with access to second rate services.
This government can not be trusted. They effectively said to GPs don't do out of hours. We'll get it done for cheaper. Of course the GPs agreed. The government thought they could cover 52 weekend and 365 nights a year for only £6000 per doctor. You don't see a GP out of hours because the government couldn't put a system in place. Do you really think that they'll do better this time?
Most GPs do not earn vast sums. This is just government spin to disempower the profession and you are all getting sucked in.
An oncologist once suggested an exceptionally expensive drug for a lady who had breast cancer. The hospital wouldn't pay for it, but the GP said "I won't hesitate to provide it" Private firms won't do that for you, the patient

Jon, Kent, UK

First I must say I am a GP
Second our pay. Grossly misrepresented. Not all of this money comes from NHS work. Every time a medical for your mortgage, life insurance or disability living allowance is needed we have to fill these in. So some of our income is private not NHS. We also have to pay not only our own pension contributions as employees but also out employer contribution.
We have quite large legal fees per year around £5000 to pay for legal cover, not to mention BMA and Royal College Fees. Income is also earnt for teaching (training doctors/medical students).
Out of Hours has stopped being a core responsibility because we are no longer on call for when the skills of a doctor are needed but more and more "working" seeing patient after patient we have never met with increasingly more complex demands of a service that doesn't have the capacity to cope. So yes many of us nolonger wish to work a long day (and dont be fooled to think that while we are not in surgery seeing ....

Leslie, Midlands,

... patients we are doing nothing. Who do you think reads all the consultant letters looks at the bloods results and works with the hospital doctors to create the local services you have.
You the public are being asked to help bring the NHS to its knees.
If i were you and I am not telling you what to do because I am a doctor I would be careful what you are wishing for, and what information you are given by a government known to tell lies and manipulate.
I too have worked in private services overseas where the doctor only makes money when seeing a patient, you have then become income not a patient
instead of this petty name calling and fighting we should as a nation be proud of what we have and work to improve it not act like little children in the play ground seeing who has the loudest voice. It will be the people with the smallest voice who will suffer.

Leslie, Midlands,

GPs are to all intents public sector employees. You earn over twice the public sector average for other professions (lawyers, surveyors, engineers, accountants etc). Your earnings are in the range of a tiny public sector elite (judges, very senior civil servants, very senior officers in local gov etc). Your pay is disproportionate and excessive for this sector! Look longingly to the private sector, but here is a comparator - lawyers. After academic education there is massive competition for places in the final stages of training - up to 50% of law graduates fall by the wayside. For those who survive, massive competition after qualification as a barrister or solicitor for the best jobs. The best can earm 1m or more, the average 70k, others nothing at all. All this and having to compete for clients. If you're amongst the best GPs - go private, as you're currently carrying the mediocre. If you're average, prepare for a massive pay cut as the best take your work. Welcome to the market!

Graham, Oxford, UK

Peter, Southampton. Interesting that you place yourself alongside judges and high ranking army officers. The thing about these comparators is that they represent a tiny elite - not the rank and file of a profession. A navy captain in charge of a large ship, numerous personel and massive destructive power is only paid about three quarters that of a GP. Lawyers in the civil service about half that of a GP. If only the most senior GPs in charge of large practices (the chief execs, so to speak) were being paid 100k + I wouldn't be writing here. But it is extreme arrogance for EVERY GP to be compared alongside generals and admirals etc. To borrow from and paraphrase Mont Python, GPs seem to want to be some communal, autonomous collective - all equal in status but paid as if they were all 'generals' or public sector chief execs.

George, Brighton, UK

disillusioned GP, Stockport. Someone else mentioned earlier the arrogance and self-importance of drs and your final paragraph sums this up perfectly. It is for patients, not drs, to make this decision. Personally, you might get brilliant feedback from your patients - obtained in a suitably anonymous manner - but I know no one who is particularly satisfied with either access to or the performance of their GP. Contrast with my dentist (whom I pay on an NHS or private basis depending upon the work). As he is only paid when I choose to visit him I get a good access and good (and effective) treatment. He knows that if his service slips I can go elsewhere (especially if I pay privately). My natural instict is to keep GP services free at the point of use, but after reading some of the dr posts I would quite like to see GPs survive in a free market. Some would get very rich, but many would experience unemployment. Before you cry shortage - how many new medical school places in recent years?

Graham, Oxford, UK

Rimie S, London. I've never said that GP pay and teacher pay should be the same (although we are in interesting cultural territory here, there are other - more enlightened(??) - cultures where teachers would be at the top of the professional pile because they underpin ALL aspects of the future wellbeing of society. Sometimes we do have to look outwards from our own personal socialised box). I agree with those comments which highlight the fairness of the proportion. I agree with the comments that when GP pay was about twice that of teacher pay and GPs worked unsociable hours that didn't seem particularly unfair. The current contract at 3x the pay of a teacher and better hours is unfair and nothing said so far has persuaded me otherwise. Also, all this talk about the responsibility of drs. The public sector surveyor or engineer who carelessly inspects a bridge could be responsible for dozens of deaths, yet is paid about 40-50k. Drs exploit power, simple as that!

George, Brighton, UK

Stephen, Cambridgeshire. May I suggest that you continue into general practice, provide a good service and avoid letting greed get in the way of caring professionalism. If you do that, all will be (reasonably) well and you should get the support of the public. What your colleagues already in general practice did wrong is look at their pay slips a few years ago, conclude that being amongst the highest paid public sector professionals, earning at least three times the national average wage, wasn't good enough and seek even more from the taxpayer. The result - public anger.

Grahan, Oxford, UK

Clive: You want quality, you pay for it. You want healthcare on the cheap, be prepared to get what you pay for. If the money wasn't decent, I'd go and do something else. Unfortunately, despite a rise putting our profession back in line with comparable ones (judges, high ranking army officers, etc) this has been eaten away in the last two years by a 0% (yes, zero) rise two years running together with higher operating costs (including wage rises for our staff). To be honest, if I'd know then what I know now, I'd never have gone into medicine with all it's petty politics and paperwork - I'd have earned more than twice as much in the city instead (plus bonuses too). There are a number of us seriously thinking about "doing a dentist" and leaving the NHS. If that number reaches a critical mass, you are all in for a big shock. There's no way I would recommend a medical career to a student these days - I actively try to dissuade the ones that show up for "work experience", which is very sad.

Peter, Southampton, UK

Neil Modha, London. I don't know anyone who respects the way in which MPs seem to sidestep the rules by which they expect the other public sector employees to comply, nor the way in which some appear to exploit their expenses system. Equally, I know plenty of people who have lost considerable respect for GPs since they appear to have joined the ranks of MPs and the like with their snouts in the trough - accepting a 30% pay increase (from an already very high starting point) when the rest of the public sector were lucky to get one tenth of that. Comparing GPs with MPs won't help the GPs' cause. GP's published av. pay (105k) is also over 50% higher than a standard MP's (60k, before expenses), so a bit risky to draw attention to this comparison.
As for the survey - no one I know was asked to participate, nor do they know anyone who participated, nor saw it advertised etc. This seems strange if it really cost 11m and didn't just ask the long term sick and elderly. Big ? over credibility.

Graham, Oxford, UK

Hello GPs! Just came across this story and thought I would chip in. I'm an estate agent so obviously everyone thinks I am greedy and selfish too. It's not too bad, with all that money just buy a des res in a gated community and forget all about what the public think. Happy to help!

David, Derby, UK

"If you think professional advice is expensive then try taking it from an amateur"

Nick Yarnall, Gales Ferry , Connecticut

Be nice to see my GP out of normal hours, as it's a nightmare getting time off.And my bank manager,or a solictor,or my MP,or the hairdresser even.I can see my financial adviser.He charges a fortune.In an emergency I can get a plumber/electrician - have you seen their charges?So it would cost a lot more.Then many GPs are now women.With children.They won't be signing up to work 4pm to 8pm as suggested.Nor would many dads.Many missed their kids early years working inhuman hospital shifts.Force them?Early retirements,drops outs, recruitment crisis.Again.Can't see the practice nurses and receptionists signing up either.Daytime stuff still needs doing,would you employ more GPs?And what about backup services?OOH hospitals provide emergency care.Not routine labwork/xrays/consultants on tap.Wonder what 24/7 full back up services would cost?Still,could raise taxes,employ a lot more GPs,force GPs and staff, wreck morale...lot of cost and grief for 16% of population.

Sarah, Nottingham,

Less than 1 in 10 people wanted GP surgeries open on evenings/weekends, 84% satisfied at assess to GP's. How about doing a survey on how many people think MP's shouldn't have that long break over summer and the fact they get such good pensions for short times in office and how easy is it to get access to your MP on an evening or weekend (weekday for that matter).>£11 million to do this survey that did not prove the point they wanted to make, so they will just make doctors do it anyway. WASTE OF TIME, WASTE OF MONEY.

Neil Modha, London, UK

re GPs getting paid more to work fewer hours -we are currently contracted to provide cover for 8.30am to 6.30pm Mon - Fri - 50 hours pw. the value put by the government for the other 118 hours pw, 52 wks pa (6136 hours) was £6000.

The previous contract was 24 hours a day, 365 days pa for which we were paid around £3000 pa for providing "out of hours cover". Stupidly I did this for 20+ yrs. Many GPs got together to form high quality co-operatives (cost me personally over £6000 pa). These co-ops could not afford to jump through the hoops deliberately imposed by the new contract and were replaced by OOH services which have a vested interest in keeping costs down.

Which posters would do any sort of work all year for less than £1 an hour? Most seem to have no idea of the complex high quality care GPs provide, including chronic disease management , perhaps because they have been lucky enough not to need it - yet. To quote Joni Mitchell "you don't know what you've got till it's gone

a disillusioned GP, Stockport,

George of London,

I think my views are quite obvious so I`m surprised that you're so surprised at my "real views", whatever that means.

Let me state it clearly and simply for you:

I think GPs should get paid more than secondary school teachers - I think it's a more demanding job.

See below for the reasons. I`m sorry that that's at odds with your view. I just don't think all professions are the same, and that some deserve to be paid more than others.

Rimie S, London,

Ian Ward. Get real! Expected to be yes, are (unless you are a very exceptional example) no chance. I've lost count of the number of people of have visited GPs countless times, sometimes over years, before the 'correct' diagnosis has been achieved. What you really mean is that you are expected not to get things so badly wrong that a court would judge you negligent. And if they do, insurance pays anyway. Medicine has always had a lage element of guesswork and the highly specialist nature of modern medicine has made it harder than it used to be for GPs to guess correctly. You might also want to think about how many patients don't sue their GP because of the sense of personally loyalty. Something else which will be lost in a move to market based general practice. At least the lawyers will get a bit fatter!

Graham, Oxford, UK

Rimie, Loonodn. At last, your real views show! What you say is what doctors have always said - we're better and more important than the rest of you so deserve more. Above the initial 5 yr undergraduate training, your training is mainly on the job. I've got news for you, ALL mainstream professions, including teachers, undergo ongoing training, acquire new skills etc throughout their careers. A dr after, say, 20 years is no more or less highly trained than most other professionals.
Consequences if you get things wrong? As a dr alluded to in an earlier thread when complaining about the cost of insurance - none personally as the insurer pays. Professional consequences - almost certainly none. It takes the GMC all its time to act against drs who murder and maim with intent. The chances of it effecttively dealing with the incompetent - virtually nil! Most of us outside of medicine reject the arrogance of drs shown in your response. But do keep saying it - it will help to convince the rest.

George, Brighton, UK

Clive,

no, not a Doctor. But I have relatives that are. Maybe that allows me to penetrate the "secret society".

Whilst I value the work of teachers, yes, I do think that being a Dr takes more responsibility and I stand by my comments regarding hours, length of training, and would add higher technical difficulty. That's not arrogance, that's just how I see it.

What about those? You seem to think that all professions are the same. But then you did admit earlier that you don't know what a Dr actually does....which limits the value of anything that you comment...

Rimie S, Loonodn,

I will stop posting, because I'm obviously wasting my breath. Just one final point. I think I've been personally insulted, directly or indirectly, at least three times by respondents who have addressed me by name (all drs?). I've expressed my views forcefully, but everything I have said I have tried to back up with reasoned argument (whether or not you actually agree with my points). That can't be said of my opponents - especially John S, London. All I can say in closing is that if this is the best in intellectual debate that the medical profession can muster, they certainly don't need me to quicken their demise.

Clive, Chichester, UK

I think Clive from Chichester should run for PM and then we could simply judge all pay scales by the number of hours worked, regardless of content. Street sweeper, Nurse, Doctor, Teacher - they're all the same, after all....

John S, London,

Rimie, Loonodn. 'More responsibility'. Are you really this arrogant - are you a dr? Teachers help to shape the future lives of people and if they get it wrong the the consequences can be extreme in terms of unfulfilled lives, criminality, off the rails drug addiction etc etc. Failure by doctors tends to cause damage more immediately. I expect most teachers respect and value the of the work of drs, pity the respect isn't mutual. I'm not a teacher, by the way.

I would say that your last post sums up the reasons why I and so many others have become hostile to the medical profession - a level of arrogance, detachment and self-importance which has absolutely no place in 21st century service provision.

Clive, Chichester, UK

Clive of Clive,

To compare the work of a school teacher and a doctor is ridiculous. Doctors spend longer training (5-6 years at medical school, 4ish further years min postgrad to work as a GP), work more hours (longer days and no "summer holiday"), more responsibility, and much worse consequences if they get things wrong.

To suggest that the pay should be same is absurd. They are not equivalent professions and to even suggest as such shows that you don't seem to understand what a GP does.

Rimie, Loonodn,

As a GP, I work long hours, I am expected to be 100% correct in every diagnosis I make, and on occasions, people can literally live or die according to my actions.

How many other professions have that level of responsibility?

As for the claims about pay, I as, in common with many other GPs, have never had that much pay to take home.

Ian Ward, Southampton, UK

It really is quite awe inspiring how much government and media spin is clouding it. Not too mention a lot of hot air being spouted.

I'd like to ask a couple of simple questions to the CBI.

1)How much does the British economy lose to alcohol consumption a year?
2) Why is it unreasonable for people to not be at work if they are ill enough to need to go see their GP?
3) How do we compare internationally and historically on this issue?

Or is it, given that as a nation we already have the longest working hours in Europe that this is a lame duck issue. Cooked up by an increasingly devious government and a compliant CBI to push in the direction of privatisation of primary care.

Matt Thomas, Newcastle,

Jimmy, Ayrshire - I admire your rose tinted view of how the private sector will treat you - best of luck! Also, just looking at a salary comparator web site for Aus which says that GP salaries over there typically about half the going rate for hospital specialists. Oh well, glad that you'd rather become a for profit sector drone or emigrate for a medical job with lower satus, than meet the UK taxpayer at least half way in giving something back for your 30% pay rise. By the way, I don't think the dentist comparison works, as dentists have always had a virtual monopoly over what they do (for most people hospital dentistry is not on the radar). Most private GPs just wouldn't get enough business to make a decent living. Most people would simply wait longer, get sicker and then clog up A&E. I acknowledge that this will be a total mess, but it doesn't change the fact that if GPs let their greed destroy NHS private practice lots of them will end up unemployed.

George, Brighton, UK

Richard, UK. I'm sure that most teachers would disagree with you about the hours they work. Just because the children are on holiday doesn't mean that the teachers don't have work to do. I know plenty of teachers who work into the evenings, weekends and holidays to keep on top of marking and other paperwork for about one third the pay of a GP. Even taking your figures at face value (which I don't) a teacher working a 40 hour week, 40 weeks of the year, 1600 hours in total for 35k. A GP working 48 weeks per year at the same hourly rate as a techer would have to work over 100 hours per week! I don't think that the GP repsondents to this thread have yet accepted that members of the public have an inate sense of fairness. We could accept that a GP earned twice the pay of a teacher when we could see that the GP dutifully turned out in the middle of the night etc. But 3 times the pay for less work, no. The new contract is just inately unfair, however hard you try to spin it!

Clive, Chichester, UK

I am absolutely delighted that the current Govt policy will result in an end to general practice as we know it. It is absolutely certain GP's will go the same way as the old "NHS" dentist.
These guys work far, far less, see next to no emergency work and earn more than we do - and all the crap that comes with running a business is handled by some private company drone - even better.
I for one welcome our new private health company masters!
(Think of it GP's - Comparable money, sick pay, parental leave, study leave, meetings, no more hefty insurance premiums, no need to find locums, no more accountants, no staff problems - its like a dream come true please let Gordon get on with it! - and the best bit is, if it doesn't work out - there's Oz and NZ waiting for us with good money, better weather and patients who appreciate what we do for them)

All you folk that think the current arrangement is rubbish - I seriously and sincerely cannot wait for the alternative to arrive because you know

Jimmy, Ayrshire,

Clive, UK

a) GPs do not work 9-5 - the contract is 8am to 6-30pm and most work later - our GP is often there weel after 7pm each night. There may only be surgeries, say 8-30 to 1130 and 3-30-6pm but the GP has to do admin/house calls etc. and often works weel after 'closing' time to do this.
b) You cannot compare teachers with any other profession as they only work 40 weeks of the year - give or take a day of holiday for training. Most schools close by 3-45, with an hour plus long lunch break that could be used for meetings and even if they stayed in school every nightf or 2 hours to do marking etc.they would just make a 'normal' day for most NHS professionals. They too have a generously funded pension scheme with I think less contribution than the NHS scheme.
c) MPs/businesses/private sector are all looking for family friendly hours, so why shold GP staff be any different!

Richard, UK,

Dr Jon Turvill - No, but it's amazing how quickly public sentiment can change when they see selfishness and greed replacing selflessness and caring. And come on, the govt didn't throw 30% add you without being asked - the BMA negotiators thought they had pulled off a fantastic deal, old style trades union power at its best! I wonder if they think that now - as the public's anger at being let down by their previously respected doctors rises to the surface.

George, Brighton, UK

As a trainee GP, I am starting to wonder what I am letting myself in for! It is very sad that my work will always be surrounded by politics. The NHS provision is excellent, yet I very much hope that General Practice does become privatised, if only to get away from the government lime-light.

Stephen, Cambridgeshire,

Mike, Dundee. Sounds like a description of a competent, experienced professional to me, but doesn't add any weight to the critical arguments presented here. I know plenty of teachers who are on their feet virtually non-stop between 8.30 and 3.30, giving individual attention to children in classes of 30-40 without taking breaks or lunch. They then complete paperwork and marking in the evenings and (childrens) holidays. How many of us could do that either? The difference, the teacher is paid under 40k and the GP over 100k. I would be happy to see the balance restored by all such other public sector professionals being paid the same as a GP. But until that happens (or hell freezes over!) I'll continue to push for GPs pay coming down to that of equivalent public sector professions or them accepting a workload (at practice level) which justifies the huge sums I and other taxpayers are forking out.

Clive, Clive, UK

adrian , rugeley. I expect that most/all contributors to this thread are able to keep more than one political issue at a time in mind. If you want to throw insults of this type around, you would probably be best advised to choose a different kind of newspaper.

Clive, Clive, UK

Rimie, Loonodn. I'd love to find out the facts at first hand, but as the medical profession is one of the most powerful occupational groups in the country and is able to maintain that power in no large part by operating in a very private world (I concede, unavoidable in some respects) then few of us outside of the profession have much chance of finding out the 'truth'. About the only reliable source of public information are court reports and other law related sources. What do they tell me, until patients had acces to records, a whole raft of acronyms showing disdain by doctors for those they were 'caring' for. Harold Shipman - murdered over 200 patients, whilst other GPs signed off the cremation forms, Rodney Ledward - maimed how many women with no colleagues stepping in to stop him? How many babies died at Bristol ?- one dr spoke out and was ostracised, etc, etc, etc. Let me into the closed medical world and I might change my mind about these and the other issues I've commented on.

Clive, Clive, UK

Clive, from Chichester:

Your descriptions "**sounds like** a pretty mundane admin dominated type job" and "management of chronic conditions **sounds like** dishing out repeat prescriptions etc" plainly give away the fact that you don't appear to know what GPs do.

Why rely on "sounds like" as opposed to finding out the truth? Do you always comment without the facts?

And as for the ranting, you should get your blood pressure checked....

Rimie, Loonodn,

oh dear, looking at some of you and how upset you are strikes me that you need a good GP to sort out your over-awing disatisfaction with life.

This is good politics; destracts and destroys and keeps people away from real issues like Iraq. The media like blind fools lap it up.

At this rate it will be as bad to see a doctor as a dentist once the government have destroyed the medical profession, accompanied by the naive ; many of whom have posted above.

adrian , rugeley,

I've just been off to see my doc. I was something like number 25 in the list of 30 she was seeing before going off to do home visits. There are 3 other docs in the surgery. That makes 120 patients in a morning. Just look at it - 6 or 7 minutes to see me, sort out my problems and deal with my paperwork. I think that's amazing.
I know if they opened into the evening they couldn't see everyone in the day.
On another point, my wife got ill earlier this year but only felt vaguely unwell. She was sorted out in that time and referred onto the right place for urgent treatment.
How many of you writing on here could do that?

Mike, Dundee,

Saul Galloway, Leatherhead. Please, credit readers of the Times with a bit more intelligence! Do you really think that the rest of us take home whatever the starting figure is for our annual salary? Pension contributions, illness insurance etc are hardly unique to GPs and if you have a half decent accountant these expenses will be given maximum tax saving advantages (I even heard a few years ago of a scam amongst some GPs of employing their spouses - who didn't actually do any work to speak of - as admin support to save tax. Hopefully the Revenue have cottoned on to this by now). And finally, even taking your figures at face value - you still admit to earning twice that of an average secondary school teacher - whose work, I would argue, is at least as onerous as yours.

Graham, Oxford, UK

Fenella Lemonsky, Whetstone. I've no doubt that some GPs provide excellent service and work well above what they could get away with. However, as many/most of the non-medical responses on this thread show, the more common experience is of a greedy, business mentality of putting the least effort in for the most reward out. See, for example the Sunday Time article of 19 August - Patient access is ‘sold’ by GPs. Maybe your GP employers should take a stand against these business minded colleagues and remind them that they are first and foremost supposed to be caring professionals who took the hippocratic oath, not business people. They may even give some thought to what the oath means in the 21st century - are you doing harm in pocketing money diverted from elsewhere in the NHS? Who knows, if your employers provide such a good role model they could even give the GMC a kick and remind it that it is supposed to uphold PROFESSIONAL standards!

George, Brighton, UK

Goverments own figures show the average GP earning 100,000 per year. From that they pay about 5,000 per year for indemnity insurance (so you can sue them), about 20, 000 per year for their NHS pension (employers plus employees contributions as most are self employed) plus about 2,000 in professional expenses (GMC dues, subscription fees etc) and about 4,000 illness insurance (if they're ill themselves they have to pay more than they would have earned to provide a locum, and theres no sick pay entitlement). There is no paid holiday at all. 2 weeks locum costs about £2000.

So the true average earnings when compared with a salaried employee are about £67,000/year, and for an average 44 hour week (again govt own figures) thats about £29/hour before tax.

Private sector competition, bring it on! Weekend and evening work, happy to do it if the government (public) would like to pay for additional hours to satisfy the 4% who are said to want such a service.

Saul Galloway, Leatherhead,

I'm self employed, and I cant afford to take time off from work to go and see a doctor. I currently have a few things that I'd like looked ta, but because its almost impossible to get in, I dont bother. If \ When it becomes serious and I have to go to hospital, then I'll call an ambulance, and we'll see what happens. I dont understand what the fuss is all about. Regulated competition is fine. In Australia we have medical centres everywhere, and you can go to any centre without needing to register. Just show your medicare card (like national insurance card here), and its fine. There is too much bureaucracy here, all this business about needing to register so that funding can be provided. Its unnecessary (see Australia as an example), and most people simply dont know what they are missing in terms of how it COULD be done better.

Roberto Maietta, London, UK

Don't hold your breath. Control is something this Government doesn't have. Doctors tell them what to do.

Judy , Liverpool, england

Instead of longer hours, why not allow patients to register with a GP near their place of work? Let money follow patients and it would work. Although it would mean local doctors not having medical records in an emergency, simply make it compulsory for those taking advantage of such arrangements to permit their details to be on the apparently wondrous database the government is working on. Some very large firms in the private sector (financial services to my knowledge) already need to provide in-house doctors to address this problem, why not open it up to all?

JS, Cambridge,

Lesley, London. How do you know that your patients are happy with the arrangements you provide? Have you asked them in a anonymous way so that they can be honest in their responses? If you have, fair enough but don't expect patients on mass to criticise openly when they fear (however unfounded this may be) striking off a dr's list or inferior treatment if they complain. All that I can say is that I have NEVER been asked to comment on any GP or other medical service I have received. Seeking honest opinion about customer satisfaction seems to be the last thing on drs' minds, and why should it be? GP practice in terms of a monopoly market has few parallels outside of the old soviet block.

Clive, Chichester, UK

Do pardon me for this but as a simple person I had always believed that the National Health Service was just that, ie National, and that there was no private sector. Are we being told now that the Labour Government has privatised part of "their" flagship service. I must ask on who's authority and when?

Francis J. P. Offord, Newcastle upon Tyne, Northumberland

As a GP I am sick and tired of the DH and the media taking pot shots at my profession. I am a partner in a 10,000 patient practice and in the last year we gave over 80,000 consultations that's 8 consultations per patient and over a thousand appointments per week.
The DH insisted on changing the previous contract and have had their pound of flesh in return. GPs work far harder now than ever before . The fact that the DH agreed to a contract and are now reneging on it left right and centre is what concerns me the most.
The DH General Practice survey cost a lot of tax payers money and showed very high satisfaction rates with opening hours and yet the government appears to be ignoring its own results in order to pursue its GP bashing agenda.

As for the rather bitter comments of disgruntled consultant colleagues- its not GPs faults that you cannot get yourselves together to negotiate a decent contract,despite having had several years to do so. You made your own bed so lie in it!

Paul Chard, Maidenhead, Berkshire

I am mortified at the thought that I could lose my doctor. As a 76 year old pensioner, I am a regular costumer of his, and I deeply appreciate and depend on his care. I remember when the NHS was founded after the War, and for years it has been held up as an example to the world, and now in the name of `choice' it is beiong wrecked. The only choice I require is to be looked after by my local doctor who is within walking distance, and by my locasl hospital! Hands Off, I say!

Bernard Rickman, Croydon, Surrey CR8 2DU

GP's provided OOH care for years at extremely low cost to HMG but at enourmous cost to their own sanity,health and family lives.This was unsustainable as OOH demand rocketed over the years by the wants(not needs always)of a 24 hour society.When the nGMS contract provided the option to give up OOH care for £6000( an obscenely low amount which just indicated how little HMG valued the GP OOH service)is it surprising that most GP's elected to give up OOH care.Now that HMG have realised the true cost of providing good OOH care they suddenly want the old system back as was so much cheaper for them and satisfied patients more(ACCORDING TO BROWN!)So blame for OOH fiasco now placed squarely at foot of GP's who really where the innocent parties here and have suffered severe denigration in press/media over income,less work etc etc.This was all well orchestrated by HMG and now Brown is threatening to sell off GP practices to private concerns if GP's don't open surgeries for longer hours for NO extra pay!! This is not in current nGMS but another unilateral decision by HMG to dishonour the nGMS, the same as they did with pension capping. HMG are not to be trusted at any cost!!

Gillian Breese, Blackpool, UK

The delegation of responsibility for the out-of-hours work was the carrot the Government used to coerce GPs into signing the new contract (and the Government was warned that nobody would do the job as well and cheaply as GPs, but we were ignored, of course).
The "payrise" was mainly remuneration for a lot of extra work under the "Quality Framework".
The average GP spends more time in the surgery now than 3 years ago, due to much increased administration tasks (with an average of 44.5 hours per week). Surgery opening times have increased, and the vast majority of patients can see a GP within 48 hours. Due to rising staff
costs etc the GP's personal income is now falling.
I wonder which other profession would put up with being called lazy, uncaring, money-grabbing shysters by the same politicians and spin doctors who caused the mess in the first place, parroted by those who are not willing to pay more taxes for their convenience?

Dr A Lehmkuhl, Swindon, Wilts.

Private GP providers cost more than traditional GPs, and that the Gp's that are paid to work there often leave, since they have no stake in the day to day running of the surgery. What ill patients with ongoing problems want is access to their own GP that they know over the years and whom they trust. What the floating voters of Labour's target audience want is any doctor, the moment they feel the need. We've seen the effects of privatizing General Practice. Most OOH services are run now by private providers. To argue that because the privatization of OOH has been disastrous, that the rest of general practice should be privatized to fix it is a nonsense that only spin doctors could think sensible.

Dr Gwion Rhys, Nefyn, Wales

Roger yes the BMA is indeed a union. The point here is that there is no demand for longer opening hours. As point out in the article a recent survey showed no evidence that patients want theses services. Furthermore practices that have experimented with extended opening hours have not seen their list size increase this would suggest that their is no demand for these services.

Paul Turnbull, Alverstoke, Hants

My family aim to visit a doctor when making trips abroad as foreign doctors give you much better treatment and actually care about the patient. My sister for example, was complaining of stomach pains for quite a while and all the docs did was to tell her she would be ok without much examination. On a recent trip to Iran she went to the doctors and had a scan. The doctor was angry with her and asked her why she hadn't visited a gp in the UK. She was in tears and responded that she had been many times but they didn't do anything about it. She had a fluid build up in her stomach; had it been left for any longer it could have been life threatening. Luckily now she has been on medication and she is better. So now when she comes back from her trip there will be quite a few complaints going to the gp. Not sure whether that will make a difference to their attitude though.

Amin, Hampshire,

Another threat from Government, is it not already the private sector who are providing care outside of the normal GP practice that have been criticized over the lack of care they are providing, the Govt ignored that survey I see, have they not listened to the 11million pound survey that states people are happy with GP opening times. I agree there needs to provision were there is not sufficient and the private sector may fill the gap until they realise there is no money to be made anyway. Has Gordon not grasped yet that by extending opening times with existing resources it will stop the elderly and vulnerable or those with chronic disease from accessing these services, as they do not want to travel in the dark and cold when there bus passes do not operate etc. How many more threats have GPs to take when they are providing excellent services, according to their own survey. Gordon may want to leave a service alone that is working well, and not use it as a smoke screen to hide issues.

Eric , durham, England

The surgery I work at has opened on Saturdays and in the evening, both of which were poorly attended. Also there is the added cost of keeping surgeries open. Who will pay this? The issue of patients wasting doctors time will never change, but sadly this affects everyone, especially when people cannot get an appointment when they want it both at GP and Consultant level. The amount of money wasted on administrators does not help anyone at the end of the day.

carole, tamworth,

Did so many people despise their GP services and those who provide them before the new contract? I feel very disheartened by reading most of these comments. It suited the Govt to freely negotiate the contract, and they called the tune as they always do. Performance related pay was the requirement, and we performed. Trouble is, preventive medicine is low profile, and no one seems to value it, though it is about keeping people well.
So now it suits them to rubbish our apparently lavish pay and relaxed work commitments. sorry, but it is still difficult demanding and stressful work. Many of us still do out of hours work, though we work for the NHS rather than ourselves. I have 2000 patients, that is £50 per patient per year. My tumble dryer insurance costs more than that. Choose big private companies if you wish, and watch the costs soar, as they did when out of hours changed.

Dr Jon Turvill, Haddington, Scotland

Christina Monroe, Belfast - I'm sorry, but it's difficult to believe that GPs are the victims of goverment spin when they got a 30% pay rise for less work. Anyway, contracts almost always set a minimum level of provision not a maximum. If GPs out there are really feeling so bad that all of this money is flowing into their bank accounts whilst they are not 'allowed' to see patients out of hours, I'm sure that they could use their considerable intellectual power to devise a solution. Perhaps private out of hours cover for their patients, but free at the point of use - ie the drs themselves are really paying. I'm sure that all readers of the Times are well aware of government spin, but you are not showing much awareness that the medical profession are themselves very adept at spinning - after all its kept them at the top of the professional pile for a century or more.

Graham, Oxford, UK

I order to improve the service of G.P.'s you have to tacke those who are in charge of the surgeries - the receptionists, clerks etc who are the sole determinants of when you can see your G.P. or collect your prescription - those whose assumed authority is often not matched by knowledge, experience and intelligence.

Out of hours service could be solved by doctors taking it in turns on a rota basis to man a surgery and this would be greatly assisted by chemists opening longer - all for the health of sick patients! If we cannot do this, where are all these additional medical staff to be found?

Rodney Barker, Gainsborough, England U.K.

These proposals ignore the inevitable implications. GPs do not work in isolation: they need support staff, nurses, blood tests and X-rays, and these are not available 24/7. Patients seen at their convenience will have to return on a weekday for these services. And if a GP works on Saturday or a weekday evening, they will do less surgeries at times when the vulnerable and elderly need them - during the day. Finally in many areas there is still an excellent out-of-hours service with predominantly local GPs doing the work. By all means improve these out-of-hour services. But the proposals described here are a knee-jerk response and will prove disastrous. Our patients have voted strongly in favour of existing services. This is doctrinaire nonsense.

Dr Stephen Linton (GP), Farnborough, Hants

This is a most unfair directive. The contract which the government agreed allowed for an opt out. The government itself decided to hand outof hours contracts to private providers, so that many local GP-run co-operatives have had to close. Many of these private provider services provide a poor overall standard of care and have swallowed up money as doctors have been flown in from abroad for shifts and Primary Care Trusts have had to keep injecting money to keep then afloat.. The patient surveys show that the majority of patients are satisfied with current GP hours.The DOH's civil servants are merely scapegoating GPs to explain away their own past mistakes to their masters.

Monique, Maidenhead, Berkshire

Good luck to all of you who think that private companies could provide a better service than GPs already do. My experience of dealing with doctors from such companies is not reassuring. When you are ill it is better to be seen by someone who knows you, and whom you have built up a relationship with, rather than a different doctor each time. That said, I am a GP and there is NO WAY that I will go back to working 24 hours/weekends. It is not safe for me, and I have as much right as anyone else to a reasonable work-life balance. Here's a shock for you all: Most GPs do their job because it is enjoyable and pays well in return for years of studying and long hours training. If we were forced to work longer hours then the majority of us would pack it all in and go and work somewhere we are appreciated (New Zealand anyone?

James, Solihull,

There are 168 hours in a week. Would you trust your GP's judgement if they'd been working 120 hours of that week?

Zoe Goodman, Leeds, UK

I cannot believe that the public are hapy with the GP service as it stands at present.

Today I needed to see my GP as a matter of urgency. It is no longer possible to phone for an urgent appointment as it always takes so long to get through that be the time you do all appointments have gone. That is after continuously redialling until you are answered.

Now we have to visit the surgery in person and be outside well before 8.30 when they open to get an urgent appointment. Today there were at least 40 people in the queue by 8.30. Unbelievable in the 21st century.

It is time this was addressed along with evening and Saturday surgeries.

Malcolm Winston Jones, Telford, Shropshire

This is utter rubbish. While I dont think private practises is an appropriate answer, something has to be done about access to GP's. I don't know where that survey was done but I suspect that there weren't more than 5 people surveyed and they were all doctors or partners of doctors. Everyone I have spoken to agrees that only getting access to GP's during office hours is ridiculous. I personally would be happy if the current out of hours service was available during office hours and the proper GP service was available evenings and weekends. I don't think GP's are doing a better job but they are certainly earning a lot of money. I know a lot of people who don't bother trying to get health problems sorted because they can't get to see a GP without taking days off work. In the long term this means a lot of serious problems that may require surgery and other expensive treatments simply because it did not get picked up early on by a GP.

James, London, London

Why bash GPs. Consultants in hospitals see far fewer patients and earn twice as much and finish at 5. GPs are now expected to manage chronic illness when traditionally their consultant colleagues would do this. No longer. GPs manage unstable complex diabetes, heart disease, mental illness-all the things their specialist clleagues used to support. I didn't see consultants take a pay cut for managing fewer long term needy patients? MY GP works very long hours 8am to 8pm 5 days a week and gives all her patients what they need. If she is good at her job and works these long hours and has worked hard and studied hard why penalise her?
She looks after mentally ill, unwell diabetics, and many others who secondary care won't touch(money!). Additionally she does her visits inbetween seeing 40 patients a day. Until this government stops bashing the very hard grafters who keep the nation alive it will alienate itself further away from them.
I work in primary care and see it from frontline.

Fenella Lemonsky, Whetstone, UK

In my home country, GPs usually group themselves and take turns covering evenings/weekends. When you choose to become a doctor, this is what you expect as normal. It works fine. Why can it not work in the UK?

Manon, Glasgow,

So "the amount lost in the economy for people taking time off to go to the doctors is huge" is it?

Well why don't you go to the GP during the week and spend your own after-hours catching up with your own work? What's sauce for the goose...

mark, sydney,

The GP contract specifically divides the day into in hours and out of hours periods. Renegotiation of this needs to occur to get existing in hours providers to provide additional medical services in the out of hours period.

There is no need to change the existing arrangements; just better "policing" by primary care trusts (PCT's) to ensure existing providers ie inhours doctors and out of hours doctors are offering avaliability within the guideleines. If not then the PCT's should commision alternative providers to do the job which the existing providers cannot deliver

If the NHS IT programme was running to plan medical provision would be significantly enhanced

C Quartly, Dunstable, UK

Mike from Canterbury is correct. I also live in the rural area in Kent. My nearest GP service is 4 miles away. This I do not mind driving to. But when I need to see a doctor on w/e for my children or us (so sorry we can not plan it in to the working week Mon- Fri 9-6 when we will get ill). We have to travel to Herne Bay which is about 15 miles away. What has happened to this crazy society we live in. OK for us as we have transport but if we couldnt drive, how on earth would we get there. Maybe we should plan in advance when to get ill. Luckily for us we are healthy people and try to sort things out for ourselves.

liz hobbs, badlesmere, kent

N Stoffberg-GPs are no longer responsible for out of hours care because of the contract with this Government that was forced through. In many areas, GP co-ops wanted to continue to provide care but were prevented from doing so as the PCTs preferred to use independent sector, mostly American owned companies. The GPs weren't even allowed to see what the many of these companies were proposing or charging to provide services.

Get it into your head-its not the GPs fault. Its entirely and wholly the fault of this government.

Not a doctor or a GP, just tired of people believing everything this Government is trying to spin about them.

Christina Monroe, Belfast,

Pretty typical - Government Survey of public opinion doesn't support evening & week-end opening, so they do it anyway! Whether it's GP's or private companies offering it the poor bloody taxpayer is going to get screwed again. 12-20 billion (depending on who you believe) on the National Programme for IT in the NHS, which should be a national scandal, now this. Who says Labour doesn't line pockets in the private sector?

Jon, Bath, Somerset

The goverment is right, our GP is only open 9am-11am, 4pm-6pm monday to friday, and when you want to see them you have to wate 3 to 5 days, no wonder the hospitals are over worked as thats the only place that will see you the same day.

Bert Billingham, wolverhanpton, west midlands

Ther is a huge dissatisfaction beytween a traditional gp practice owned and run by gps and one with employed gps............there has been a sea of dissatisfaction with the latter.............secoundly I come to work at 730 am to start paper. Work and rarely get home by 630..........You can not expect this of an employee.......we have an employed gp and due to contractual restrictions and working time directives ect I estimate to replace each whole time equivalent with a salaried option would cost about 1.5 times as much.Don't underestimate the cost!

bsingh, cambs,

The DoH WANTED us to opt out of Out-of-Hour services- remember NHS Direct and Walk-In centres and how Nurses would provide the service? It was entirely predictable that OOH would fail as the DoH woefully underestimated costs.Please make it clear that it the DoH that provides OOH services NOT GP's, and it is the DoH that has failed. The DoH assummed that GP's and Consultants did no work and played golf all day-they produced productivity related pay - and now it is our fault we get paid? Sadly, not as much as the DoH is spinning but the truth never got in the way of a good story.

Dr A Smith, Epsom, Surrey

The BMA is a union

tom, barnstaple,

Matthew from Cambridge - teachers are typically paid well under 40k pa, refuse collectors and road repairers a lot less. GPs can't have it both ways. If you were paid the same as other public sector professionals - 25-50k for teachers, lawyers, social workers etc - and you were being expected to work evenings and weekends you would have my support. You don't have my support because you are paid 100k+ - three times or more the pay of a teacher - but want a 9-5 weekday only working life. The service you provide is not worth that - get it?

Clive, Chichester, UK

'Costing what GPs do'. This description sounds like a pretty mundane admin dominated type job to me, certainly not worth £100k+. Management of chronic conditions sounds like dishing out repeat prescriptions etc. The only exceptions are 'home visits' and dealing with emergencies - neither of which most GPs do anymore. It is often said that Drs are very reluctant to visit their own GP when ill - maybe they should, then they would see how unsatisfactory the current service is. A bit more critical self-reflection wouldn't go amis instead of this constant, arrogant, drs know best attitude. Remove the responses of drs from this thread and see how much public support you actually have.

Clive, Chichester, UK

Jo, West Sussex. Where's your evidence that doctors (especially GPs) were underpaid before the recent contract? International comparisons? I don't think so, UK GPs are said to be the highest paid in Europe. Other public sector professions? Lawyers in local government and the CPS (similar levels of traing to a Dr) earn about 40-50k or less. The levels of ignorance displayed by some doctors about the world outside of medicine is incredibe. Have you thought that Tesco et al are so succesful because they give the public what they want when they want it. If you come down from your high horse you might realise that whilst drs offer highly skilled expertise, in essence it is a service like any other and service expectations change over time. By all means look back to some imagined golden age (when all shops shut at 5.30) but don't be surprised when the public whose taxes pay you are hostile, demand change and better value for their money.

Graham, Oxford, UK

For the vast number of patients who work 9-5, surgeries staying open till 7pm and on Saturday mornings would make a huge difference.Many of us have to take the time spent visiting the GP as annual leave, particularly if we commute into london.

G.Perrett, winchester,

I for one am quite happy to see my GP during working hours. Why should I have to use family time to see my GP. I work very hard and time at home with my wife and children is much more precious than time at work.

If I need to see my GP then I'll see him during working hours. Just like seeing a dentist, solicitor, plumber or electrician. The CBI and Government are spinning this around so that we don't take time off work when clearly we should to look after our health. My GP gives an excellent service and the last thing I want is him seeing me or my family after he's been up all night seeing things which could have waited until the morning.

Jon, Reading,

GPs are a waste of money. They are glorified overpaid gatekeepers for specialists. Given advances in medical knowledge they are vastly over qualified for many of the jobs they do and vastly under qualified for the rest. We would do better, like France, in making it possible to make direct appointments with specialists, and having larger, well staffed, diagnostic/minor treatment centres. The current structure with GPs benefitting from all the good bits of being state employees - job security, no accountability, no competition, fantastic pension, no need to treat patients as if they are customers who pay their comfortable salaries - and all the good bits of being self employed (tax) is unacceptable. Oh, and how I wish they would stop sanctimoniously telling us how to live our lives and interfering in every area of public policy. Who asked them?

Angus, London, UK

There is no public support for GP's on this issue. The usual British sickness of wanting more money for doing less work has infected the GP community and if they carry on messing around like this and avoiding their responsibilities then they will rapidly find themselves unemployed and with an oversupply of doctors they can be quickly replaced.

phil, london, uk

We should welcome the idea that services provided by the state be open and accessible in the evenings and weekends.

For a start I would appreciate my bins being emptied on a Sunday (so that they are not left on the street while I am at work on a Monday).

I would welcome an extended presence for all highways maintainence to reduce the time I spend in traffic jams on bank holidays and weekends when the rest of the country also wants to travel.

Perhaps schools should offer all year round education to allow parents to take holidays without paying the premium prices caused by a glut of demand with the current system?

Finally I would like to be able to speak to my MP when I want to (after my work); tonight I will work until midnight (as a doctor) so can you book me in for 00:30? - emergencies permitting.

Matthew, Cambridge,

GPs have taken the British taxpayer for a ride over the past years. They are now grossly overpaid relative to their skills, and to the service they offer. For too long they have been "untouchables" holding the man and woman in the street to ransom whilst providing a service always on their terms and too often marked by rudeness and arrogance from their staffs.

bob, lincs,

How many people use 'the GP Appointment' as an excuse to have time off work?? eg for job interviews etc.
The figures relating to time taken to visit Gps from work need serious challenge. It is not a black and white scenario and I would be very grateful if The Confederation of British Industry could acknowledge this.

Costing what GPs do, which is significant multitasking between chronic disease management, attending to emergencies, home visits, dealing with day to day medical problems for non chronically sick patients, feeding the computer with all the data that needs to be counted let alone the mountains of paperwork, will reveal that to get these tasks done by the private sector individually, will cost vastly more than the current scenario.

There really must be a better insight into what goes on in surgeries by all the powers that be. Surgeries have a very high satisfaction rating in the National GP Patient survey. But it seems dismantling General Practice is well on the way

DR Sian Job, London,

I don't want a tired, exhausted doctor who has worked all day to see me late in the evening, I'd rather be seen by a "private company" doctor who has just started to work the evening and is fresh and ready to diagnose and treat properly.

Nigel Entwistle, Ravenglass, Cumbria

Doctors contract was forced upon them because government, as usual, think they know best.
atest Gov patient survey has high satisfaction results for doctors by patients and instead of celebrating this, they go out to bash GPs - typical !

They made the same mistakes with NHS Dentists and are driving them out of the ungrateful NHS system through bullying - sounds like they want to drive GPs out of the NHS and make it more Private too. Typical example of how NOT to encourage and motivate your workforce by incompetent Government ministers who are on 100k+ and should be replaced by private sector expertise frankly!

Sam Redman, London, UK

Brain drains only arise when the grass is genuinely greener elsewhere. GPs might be in for a shock when they realise just how cushy their current lot in life is. Anyway, top surgeons may be able to command attractive packages elsewhere, but GPs? I'll watch with interest, as this would be a genuine example of testing market forces - funny, I thought that was all the government were threatening anyway!

George, Brighton, UK

I order to improve the service of G.P.'s you have to tacke those who are in charge of the surgeries - the receptionists, clerks etc who are the sole determinants of when you can see your G.P. or collect your prescription - those whose assumed authority is often not matched by knowledge, experience and intelligence.

Out of hours service could be solved by doctors taking it in turns on a rota basis to man a surgery and this would be greatly assisted by chemists opening longer - all for the health of sick patients! If we cannot do this, where are all these additional medical staff to be found?

Rodney Barker, Gainsborough, England U.K.

Let the "Brain Drain" begin.
The good GP's are not going to stay unless there are good opportunities in the Private Sector . At present this sector is employinh young and Naive GP's

Patrick, Sheffield,

As a doctor, I am sick of all the doctor bashing that is currently going on.

This government negotiated the original GP contract and are now trying to renage on it because they did not forsee that GPs actually do get the work done and thus earn the money available from the contract. Doctors had been underpaid for years before the recent contract came into force, we are now on a par with other professionals.

The problem as far as I see it is that doctors are expected to be open like supermarkets - around the clock. If that happens then you will find a service run by junior staff, with increased errors and litigation. Who are you going to complain when this happens; Tesco or another private firm who is going to take over the services??

What next - clubcard points for a visit to the doctors?

Jo, West Sussex,

I have worked in a GP practice for over 10 years, the opening hours of which were from 8am til 6.30 or 7pm. The majority of patients were and still are happy with this. it is my feeling that the onus lies with employers who, increasingly, do not allow employees from taking time off to attend an appointment to see a doctor. In the majority of cases for so called "emergency " treatment, people who asked to be seen out of hours are those who cannot or will not take time out of their busy work schedules to maintain their health. Surely this "work til you drop" culture should be addressed first. Perhaps it would cut down on the amount of time and resources wasted due to non attendance at both GP and hospital appointments and would decrease the burden on A & E departments and minor injurie units in evenings and weekends.

Lesley, London,

After a quarter of a century living outside this country, I returned to find that UK GP’s are worse than the most indolent and greedy public servants that I have encountered anywhere in the world. Replace them!

Disgusted, Cheshire,

GPs average salary is now £100,000. For this they work 9 sessions per week (4.5 days) from 8 until 5. There is no on call work outside of these hours. That they earn quite so much money having opted out of the strenuous (on calls from home two to three times a month might not sound quite so strenous) part of their job is appalling. In any other public sector job a £100,000 salary would entail far greater commitment.
As a hospital physician, you would be right that I have an axe to grind. Following medical school, training to become a fully salaried GP takes 3 to 4 years. Training to become a hospital consultant takes 10 years. Guess who does 4.5 days per week and still does on calls? Guess who has the greater salary?(£70,000 vs £100,000)Guess who looks after patients with more advanced, complex medical needs?(i.e. chemotherapy, surgery, heart attack, stroke).
GP's have lined their pockets with taxpayers money - how much longer will we all have to put up with their overpaid whingeing

adam, manchester, england

I agree that involving the private sector in the running of GP services would be a good thing. Since the new contract was introduced in 2004 there has been a sharp decline in access to primary care despite what the government are saying. I don't believe the Government survey of GP services. It sounds like they have applied their own spin for political reasons.

Access to GP services was far better before the new contract. At least you could see a GP when you needed to rather than having to run the gauntlet with the surgery receptionist.

GPs earn such huge salaries and should be available to the public when they need them. Being a doctor is not a nine to five weekday job. People are sick in the evening and during weekends too.

GP care is more ongoing than episodic in nature. People want to be able to see their own GP not some stand in locum who does not know them or their family.

Alastair Foster, Harrow, Middlesex

There will never be an effective health service until the patient has some say over the practitioners income. In France the system works much better on a point of service payment system. The patient can then reclaim the payment from the state. This makes the doctors far more interested in satisfying the patients needs.

What possible incentive have the doctors when they are paid exactly the same whether they see their patients or not.

When my sister was dying in a London teaching hospital, a particularly arrogant registrar loftily informed me that some people paid him for his opinion. I know, I replied, I'm one of them. Presumably, though not evidently, the man was intelligent, but he was visibly quite startled by the concept, and had obviously thought that his hospital salry was just some sort of extra to his private practice.

Jane O'Neill, London,

If the £11 million survey (silly money and point I know) done by the Govt showed the majority of patients are satisfied with the current opening hours, why are they so keen on pressing ahead with extending opening times esp with "private companies" ? One has to wonder if there is any alterior motive in the govt's "privatising binges". Private this, private that. Don't forget private companies have shareholder's profits to cater for. Look at the private prisons for god's sake.
I work for an out of hours "private" company which used to be run by just GP's. Workload increased, patient waiting times increased as they are employing cheaper but slower nurses to provide phone advice. We are not allowed to fax prescriptions to chemist, forcing patients to travel to collect them even if they live miles away....to save costs on the faxes. Probably to squeeze all possible profits for the shareholders no doubt.

david, bristol, uk

The risk a doctor takes is unmatched by any profession. Thus, medicine is incomparable to any profession.
As non-doctors insist on an unreasonable return and lifestyle for doctors, they will only worsen patient care.

Jon, London,

The new GMS contract in 2004 allowed GP practices to opt out of responsibility for OOH cover for emergencies at a price: 6% of basic practice income
The reason for including the option of opting out was the ever increasing number of partnership vacancies: income fell drastically with every vacancy while workload increased, leading to recruitment problems. If this effort to force GPs into working close to 24/7 again is successful, it is likely to produce the same scenario - inability to recruit or retain GP partners. This might be what the government hopes will happen.
It would seem that because something like 4% of respondents to leading questions in a postal survey would have liked practices open earlier or later, the new prime minister would like routine - not, as previously, just emergency - surgeries at all hours of the day and night, including weekends.
I'm a GP: I've been there: I could not do it again: nor should anyone. Too late to retire early (>60) - but I can retire

Mary Hawking, Dunstable, UK

Its about time the private sector was allowed to operate in this sector of healthcare marke. This should be taken one step further and private companies should be allowed to operate during the week through the own surgeries and govt should contract the healthcare services to the most efficient and competitive providers rather than be stuck in the present inefficient system which is not providing value for the govt. and patients.

Tony, Leeds , UK

I bet the 16% who objected reflected 100% of those surveyed who actually work - rather than the non-working sectors that the NHS is now designed to cater for.

We currently have a two tier health service - only it is those paying for the service in tax that are under served.

Give us a tax break for going private and then see what's left of the NHS and how much GPs get paid.

Benjamin , Gloucester,

Tony Blair knows all about launching an unjust war - Gordon Brown is going to learn the same thing if he takes on the GPs over access.
Of all the NHS services that exist, the public are happy with the service they get from their GP practices - the Government's own recent survey showed this.
Sadly for the NHS 'privatisation mandarins,' that recent £11m waste of money failed to produce the results they required.
Already David Cameron is sensing an opportunity to recoup some of his lost ground on Brown. Siding with the GPs and their supportive patients will certainly do him no harm.
No, our new Prime Minister, needs to find himself some legitimate 'winnable' targets.
Sniping at GPs will have a similar effect on Brown's standing as 'armchair' warrior' Blair experienced when he 'stuck to his guns' and launched his war against Iraq.
The end result was a discredited leader who once showed such promise - but slunk ot of office with a large hole in his foot. Beware GPs Mr Brown.

James, manchester,

Doctors seem to me to be the epitome of arrogance.They are the only people who can have their working hours cut and they are paid more money for doing so.Patients need a system that will look after them 24 hrs a day in this 24 hr society.I see doctors as greedy fat cat people who are only in it for the money and not the the welfare of the patient.

Thomas Slattery, Paisley, Scotland

My GP friend earns £30K more than my Consultant husband. He has no on-calls and works four days a week. A couple of years ago this friend even commented that "someone must notice soon". It's not the GPs fault, of course they would accept this ridiculous deal but the GP deal has in large part bankrupted the NHS. When are people such as Patricia Hewitt going to admit this?

Charlie, Manchester,

Private companies have one key objective - maximising return on their investment. Not ensuring quality of life for their 'consumers,' and certainly not ensuring customer satisfaction (this is a requirement to maintain revenue, rather than a prime business driver).

Rather than continuing down this road of populist management of the health service, using it as a tool to further politcal aims, it is time that the health service was taken out of control of the Government. The NHS should be put in the control of an independent body which sets and executes strategy based on need supported by a sound rationale rather than headlines and political ideology.

GPs have levels of responsibility that most people cannot comprehend. Let's not try and commercialise them or their services. Do we really want to start migratng to a health service where GPs work to targets which are primarily driven by the profit margin?

Colin, Glasgow,

This is demonstration of the hypocrisy of Gordon Brown this is privatisation of the NHS by the back door and private companiers like CAPIO and Network Health have already failed with ISTCs using doctors who did not meet regulatory standards for UK registered doctors as a result many opereation had to be revised or complications dealt with an ovestretch NHS. I have no doubt that these privatised practices will demand fees for out of hours services to ensure share holder profits probably £20-00. The privatised sector does not have a glorious record within the NHS the Unfit ( Npft)
for purpose connecting for health computer system is £12 billion over budget ( a salutary warninga bout ID cards perhaps). .Until the Government tackles social inequality that has risen faster under this LABOUR govt than at any time in the last sixty years the health gap between poorest and richest will widen further. 90% of the public according to an HMG survey is happy with GP services.

Rodders, Bradford, United Kingdom

Let's look at the big Picture. The goal of Government over the past few years has been to try and drive GPs out of the NHS and make it an Insurance based system. They did this with Dentists, Chiropodists and Opticians. They keep altering the Terms and Conditions Unilaterally trying to push us into Large Polyclinics of NHS provision to the lowest common denominator. These may well be staffed by East European Drs in the future, who may well be cheaper.

An NHS GP will be available to all, just as an NHS dentist is, but most of you should reserve £400-500 net income per month per person, if you wish to have good medical care in the future. Not my wish, just the consequences of current policy.

Alternatively, you can see the 10th Dr at the polyclinic for your problems. I'm sure you will be very good at explaining the symptoms after the tenth time and the language barrier shouldn't be too much of a problem by then.

Don't believe me! Ask someone from Cresswell?

John, Trent, UK

About time is what I say. We might even end up with an NHS that responds to needs of WORKING PEOPLE rather than the unemployed who seem to fill surgerys.

I'm self imployed and cant affort time off to attend doctors unless I feel REALLy ill. There is no option for out of hours short of wasting hours of everyones time at the Hospital's A&E.

Seems that teh UK provide more services for unemployed than they ever will for the tax payers.

Boss Hogg, Newark, NOTTS

Well done Gordon, he was the boss when the new contract for doctors was negotiated and gave the option, for very little loss of earnings, that doctors could opt out of evening and weekend cover and hey surprise surprise they opted out. Now he's trying to backpedal and claw back those very hours by srong-arm tactics blackmail and threats. Are we surprised? No. It's just the same old Gordon, caught out again and trying to make the doctor's out to be the bad guys. They aren't. Same thing with the dentists. Who's next.

Trisha Cornwall, Bude, Cornwall

The power-brokers in the NHS - ie unions like the BMA will undoubtedly react with their customary hostility to this, but it seems crazy to anyone outside of their insulated, heavily protected world,