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Dr Mark Howcutt

Should general practices open for longer?

The government wants general practices to open longer for scheduled care. Two doctors with opposing views discuss this on bmj.com today.

Dr James Kingsland, President of the National Association of Primary Care and Senior Partner at St Hilary Group Practice in Merseyside, agrees with the proposal and says that it will reduce pressure on emergency services.

He argues that practices in England have "too much unwarranted variation in opening times" and the "triple aim of improved patient outcomes, improved patient experience and improved value" will not be achieved without increasing capability as well as capacity.

Dr Kingsland says access to routine appointments remains a national concern adding that already-overstretched emergency departments are being used by patients for non-emergency care.

He says the solution should "focus on improving access to primary care services" and adds evidence that a "1% increase in the proportion of patients able to access their doctor in a GP surgery is associated with a £20,000 annual cost saving for the average practice".

He questions whether there is any point introducing longer hours in primary care without increasing its capability, and asks how much longer we can tolerate "some general practices continuing to treat today's illnesses tomorrow"?

In an opposing view, Chairman of the Family Doctor Association and GP in Swindon Dr Peter Swinyard, believes that opening general practices for longer is unaffordable in the "current fiscal climate".

He says that it's time to look at the whole system for the provision of unscheduled care with the reminder that longer opening hours in general practice are for scheduled care and not just emergencies or urgencies.

He says that the recent announcement by Prime Minister David Cameron to run general practices from 8am till 8pm, seven days a week, has been met with "considerable consternation in general practice in England" and warns that the present system "may become unaffordable" within the next decade.

Dr Swinyard says that the number of consultants working in emergency departments has "risen more in line with the demand than has the number of GPs" and the pressure of increased workload is "leading to a crisis of morale in ... general practice".

He adds that introducing longer hours runs the risk of reduced continuity of personal care in general practices.

Dr Swinyard concludes that honesty is needed about what level of service the NHS should provide. He says there is evidence that Darzi centres (open 8am till 8pm, seven days a week) are "extremely expensive" adding that had the funding spent on them been given back to practices, "the excellent service demanded by our patients would be nearer to our grasp".

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