Family doctors have been warned that unless they agree to open at evenings and on Saturdays, private companies will be contracted to take over their practices.

A letter sent to local NHS organisations has ordered them to improve surgeries’ responsiveness to the public, along with people’s access to and choice of GP services. This includes the option of seeking alternative providers, including private companies, instead of GPs.

The Times understands that the letter, from Mark Britnell, Director of Commissioning at the Department of Health, was altered before being sent to tone down references to “competitive tendering” – which would include offering GP contracts to private sector companies.

But doctors’ leaders said that the final draft sent to health trusts remained “very aggressively-worded” and a clear sign of a government mission to bring more private practice into the NHS.

Changes to GPs’ contracts, introduced by the Department of Health in 2004 to relieve some of their work pressures, allowed doctors to opt out of providing night and weekend care. About 90 per cent took up the option, leaving it to Primary Care Trusts to employ private firms, groups of independent doctors and other health staff to provide cover.

The change has been the subject of mounting controversy, with patients struggling to get through to doctors’ out-of-hours and for Saturday surgeries. Meanwhile average GP pay has risen to more than £100,000.

Gordon Brown promised to address problems with access to GPs on the eve of becoming Prime Minister. His stance was backed by the Confederation of British Industry, which found that 3.5 million working days were lost last year, at a cost of £1 billion by people taking time off to see their GPs. Leading medical insurance firms have also reported a dramatic rise in the number of complaints against doctors connected to care at evenings and weekends.

The letter, which is seen as a sign of the Government’s willingness for a head-on clash with GPs, threatens to use the GPs’ contract to favour those doctors who provide longer opening hours, and to create new practices using private companies in areas where there are too few GPs.

Mr Britnell’s letter tells PCTs to come up with plans to persuade GPs “to respond to the needs and expectations of their patients, for instance by opening practices for longer periods” and suggesting that PCTs make “full use of existing contractual arrangements and other mechanisms to ensure more locally responsive services”. This replaced the original reference to competitive tendering.

Mr Britnell adds: “We expect PCTs and practices to be able to demonstrate tangible improvements for patients by December 2007”.

The letter has infuriated the British Medical Association, which says that the Government’s own surveys show patients to be content with the services offered by their family doctors.

Dr Laurence Buckman, who chairs the BMA’s GP Committee, said: “It is a very aggressively-worded letter which I don’t think can be interpreted in any other way but as giving primary care to the private sector. PCTs are being told that their performance will be judged on how well they do this. Has anybody asked the public if that is what they want? Has anybody worked out what it will cost?”

Dr Buckman confirmed that an early draft of the letter made clear that trusts would be backed if they sought tenders from the private sector to replace GPs who were failing to provide easier access for patients. This threat was implicit, rather than explicit, in the version finally sent.

The letter followed a Government survey of GPs services, which cost £11 million and found that almost all patients were satisfied with their GPs. The survey found that fewer than one in 10 people want their GP surgery to open on weekday evenings or weekends, and that 84 per cent of people were satisfied with existing hours.

Michael Sobanja, chief executive of the NHS Alliance, a group that campaigns to improve primary care services, said if the Government were aiming to use competitive tendering to fill gaps in GP provision, that might not be a bad thing. He said if it was using the idea simply as a lever to persuade GPs to sign up to longer hours, or to practice-based commissioning, it could prove counter-productive.

Mr Britnell said that the programme aimed to improve services in areas where they were poor. “There is an inverse care law whereby those who require most care are also those in the least doctored areas,” he said. “We are determined to tackle this issue.”

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