GP referrals up by 300,000, statistics show

The number of GP referrals has shot up by nearly 300,000 compared with the same period last year, official statistics released reveal.

GP referrals made in the quarter ending 30 September have risen by 12.6 per cent, while other referrals have increased by 9.2 per cent.

Inpatients

The figures also show 91 patients for whom English commissioners are responsible waited longer than the 26 weeks standard for inpatient admission at the end of October 2008.

The number waiting more than 13 weeks was 40,800, a drop of 4.8 per cent from September 2008 and 36.4 per cent from last October.

Outpatients

Out of a total of 888,000 patients, 551 waited more than the 13 weeks standard for a first outpatient appointment following GP referral at the end of October.

Of these, 67 were English residents waiting for appointments in Welsh hospitals.

There was an increase of 13.9 per cent in the number of patients waiting longer than eight weeks at the end of October 2008, compared with last October, but the numbers dropped by 14.9 per cent from September this year.

Cancelled operations

During the quarter ending 30 September 2008, 13,100 operations were cancelled at the last minute for non-clinical reasons. In the same period in 2007, 12,500 operations were cancelled.

Of these cancellations, 3.3 per cent of patients were not treated within 28 days, compared with 5 per cent in the same period last year.

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Two thirds of patients fail to get GP's appointment within 48 hours

Two thirds of NHS patients cannot get an appointment with their GP within 48 hours, a wide ranging report by the healthcare watchdog has found- and the situation is getting worse as last year 80 per cent of patients could see their GPs within 48 hours.

The most comprehensive study of its kind has shown that millions of people are being failed by their local surgeries.

Under key NHS targets, patients should be able to see their family doctor within two working days. However, the report said that just one third of people were able to see their GP within this time.

The findings come at a time when the relationship between patients and their doctors is already under strain.

There has been widespread anger over the large pay rises enjoyed by GPs under the new contract.

And ministers and GPs have been locked in bitter negotiations about forcing surgeries to open for extended hours, offering appointments into the evening, early in the morning and on Saturdays.

Gary Needle, at the Healthcare Commission, said: "Patients are not getting sufficient access to their GPs is the message from this measure."

Andrew Lansley, Shadow Health Secretary said: "Despite all their talk, Labour are still failing patients when it comes to choice and access to a GP.

"It's appalling that in seven out of ten areas, people aren't able to see their doctor within 48 hours when they wish. It shows the utter failure of Labour's top-down targets to bring about the best results for patients."

Liberal Democrat health spokesman Norman Lamb said: "For years people have known that ministers' complacent assurances about how easy it was to see a GP were wrong.

"At last a proper assessment has taken place so we can see the reality of the situation. This scandalous finding must force the Government to act now."

Last year the report found that 80 per cent of patients were able to see their GPs within 48 hours.

However, the data was gathered by using 'mystery patients' to carry out spot checks to see if they could get an appointment rather than asking patients.

This year, for the first time, the commission included information from a patient survey. The report has sparked a row with doctors who have said the figures are misleading.

Dr Hamish Meldrum, chairman of the British Medical Association said: "The report's conclusion that there has been a dramatic decline in primary care trusts meeting the GP 48-hour access target is misleading.

"There has been such significant change in the way the research has been compiled compared to last year that it is impossible to compare the data for the two years in question. The access figures are even more confusing when you consider that a recent survey showed almost 9 out of 10 patients were satisfied that they were able to get an appointment within 48 hours.

"GPs are working hard to offer as much flexibility as they can to patients, as well as providing speedy access, and delivering an expanding range of services to patients."

The latest figures show the average annual earnings of GPs, who are paid to hit the targets on appointments, are £103,530 - a drop of 2.6 per cent on last year after years of rising pay. They also showed 258 doctors earned more than £250,000 before tax last year.

The commission's healthcheck is an in-depth investigation into the NHS with each hospital trust, primary care trust, mental health trust and ambulance trust measured on waiting times, hygiene, confidentiality, management of records, reducing deaths from cancer and heart disease, cutting superbug rates and treating patients with dignity and respect.

While the report found there had been improvements in many areas, it found that infection control was a serious problem with 'lapses at almost every trust visited' and six out of ten trusts failing on at least one measure.

The Commission warned that other infections such as norovirus - the winter vomiting bug that reached record levels last winter - should be included in the measures in the future alongside Clostridium difficile and MRSA.

Of the 114 trusts that failed on at least one infection control measure, 11 said they were compliant only for this to be overturned by inspectors.

There is concern about infection control in community hospitals, district nursing, ambulances and midwifery and these areas will have extra focus in the next inspections.

From:
Two-thirds-of-patients-fail-to-get-GPs-appointment-within-48-hours.html

Polyclinics will destroy trust between patients and GPs

Plans for polyclinics or so-called "super surgeries" could destroy the trust patients have in GPs, according to a new study.

A breakdown in the patient-doctor relationship would in turn lead to more ill health, researchers warn.

More than 1.3 million patients signed a petition against the proposals for large scale polyclinics earlier this year.

GPs argue that patients will lose the bond with their family doctor under the plans, which include housing large numbers of GPs under one roof along with specialisms such as minor surgery and dentistry.

The British Medical Association (BMA) has warned that patients will be unlikely to see the same doctor each time they visit a polyclinic.

The labour Government insists that the changes are necessary to give patients a "world class" service and that, outside London, the clinics will provide extra capacity in so-called under-doctored areas.

The new study shows that patients trust family doctors less if they often have to see different GPs.

Researchers surveyed 243 patients registered at three different surgeries.

They found that 83.5 per cent of patients who always saw their regular GP had a high level of trust in their doctor.

That figure fell to just 72.6 per cent of those who often saw different GPs, the research, published online in the British Journal of General Practice, shows.

Dr Carolyn Tarrant, part of the team which carried out the study at the University of Leicester, said: "The government is setting up numerous polyclinics, super-surgeries, and walk-in centres all over the country.

"I'm sure they will have various benefits for patients and GPs, but they are bound to reduce continuity of care, and our research shows that this may lead to a decline in patient trust. If patient trust declines, then medical outcomes may be adversely affected."

Dr Laurence Buckman, chairman of the BMA's GP Committee, said: "Trust and continuity of care are exactly the reasons why general practice can't be delivered supermarket style, where choice and convenience come above everything else.

"For someone with a chronic condition, a long-term relationship with a doctor they trust and who knows their history is vital.

"GPs and patients believe polyclinics will damage that relationship, it's just the labour Government that doesn't."

The proposals were set out by Lord Darzi, the health minister, as part of his root and branch review of the health service.

A spokesman for the Department of Health said that the "overriding objective" of the new centres was to deliver the best possible service to patients.

From:
Polyclinics-will-destroy-trust-between-patients-and-GPs.html

Labour U Turn on medical data- NPfIT medical records a step closer

After another labour U turn the national electronic record of patients’ health (NPfIT) looks finally on the cards – five years late – after the NHS IT programme on Thursday changed the way patients will give their consent to the system.

Providing a brief, summary electronic patient record has been a key driver for the £12bn ($22bn) NHS IT programme, which will create a detailed, local electronic record as well as the shorter one available nationally, providing doctors with recent medical history, medications and allergies in an emergency or out of hours.

Tony Bliar, then prime minister, declared as long ago as 1997 that the electronic record would mean that “if you live in Birmingham and have an accident while you are, for example, in Bradford, it should be possible for your records to be instantly available to the doctors treating you”.

Development of electronic records, however, has been devilled by a long and bitter dispute, chiefly with general practitioners, over whether patients should explicitly give consent to having such a record – a more complex, lengthy and costly approach – or whether they should be presumed to give consent with the right to opt out – the approach that the IT programme originally backed.

On Thursday, however, Connecting for Health, which delivers computer systems and support to the NHS, announced a change of tack. Patients will now be written to and given the chance to opt out before a summary record is created.

They will in future be asked at each consultation if the clinician can look at their record and will have the right at that point to opt out entirely, to refuse for that episode of care, or to agree to the record being viewed. They will also be able to agree to the record being permanently available to accredited clinicians.

Dr Gillian Braunold, the lead GP for the programme, said the change “gives the patient control to say yes or no and it is much simpler”. The default position will be “Ask me first”, she said. The decision had been reached after consultation with GP leaders, the Information Commissioner and a wide range of others, she added.

The British Medical Association said it welcomed the changes “pending finer details”, believing patients should opt-in rather than opt-out.

The record has been piloted in five parts of the country, with fewer than 1 per cent of 160,000 patients refusing to have a summary record. Connecting for Health said it hoped to roll the record out nationally, starting in 2009 or early 2010. It is likely to take at least 2-3 years to cover the country.

http://www.ft.com/cms/s/0/ff2823e8-85d0-11dd-a1ac-0000779fd18c.html?nclick_check=1

NHS productivity falls as spending rises by billions under Labour

The National Health Service has become less efficient despite Labour pumping millions into its budget.

Official figures compiled by the Office for National Statistics show that the amount of treatment the NHS delivers is lagging behind the pace of increase in the service's budget.

Critics said the statistics showed the NHS had absorbed huge amounts of money with very little to show for it and the Government must reform its management instead of pumping in ever more funding.

NHS productivity fell by 2.0 per cent a year between 2001 and 2005, according to the Centre for the Measurement of Government Activity, the ONS unit that monitors public spending. That was the period of the biggest funding increase in NHS history.

From 1995 to 2006, the NHS annual budget more than doubled from £39 billion to £89.7 billion.

Andrew Lansley, the Conservative shadow health secretary, said the figures proved that Labour's approach to the NHS had failed.

"Spending more money if it's not spent well doesn't necessarily deliver the services you are looking for," he said, accusing Labour's use of centralised targets and management of undermining the delivery of healthcare.

As an example, Mr Lansley cited the latest central NHS contract for GPs' surgeries. A Whitehall audit earlier this year found that the contract had lead to family doctors earning 58 per cent more for doing 5 per cent less work.

The Department of Health said it was more important to focus on improvements in the quality and availability of treatment.

A spokesman said: "Ten years ago people died waiting for operations, today waiting lists are at the lowest ever. The NHS is treating more patients, treating them faster and treating them more safely

"It is also easier to access NHS treatment - through NHS Direct, walk in centres and at A&E where over 97% of people are now seen within four hours.

And it is easier to see your GP because of extended opening hours in the evening or at weekends

"There are 280,000 more doctors, nurses and other essential staff working for the NHS than in 1997 and all NHS staff have enjoyed well deserved pay rises.

From:
NHS-productivity-falls-as-spending-rises-by-billions-under-Labour.html

Polyclinics threaten 600 GP practices, say Tories

More than 600 GP practices are under threat because of labour Government plans for "super surgeries" despite overwhelming public opposition to the proposals, according to the Tories.

Hundreds of family doctor surgeries across England have been identified by local health Trusts as being in the same catchment area as proposed new polyclinics.

The Conservatives have compiled the list of practices across the country, named in plans for polyclinics drawn up by Primary Care Trusts, which they say could be killed off by the scheme.

They said the list showed practices which could be forced to shut because they would lose patients to the new clinics if they went ahead and warned that the final figure is likely to be much higher as many Trusts are still compiling plans.

Doctors who found their name on the list would now be "even more concerned than they were already" about the possibility of closure, the British Medical Association (BMA) said.

But the labour Government insisted that there was no suggestion in the documents that any of the practices had been earmarked for closure.

Recently, more than 1.2 million patients signed a petition protesting against plans for polyclinics, which was delivered to Gordon Brown.

Doctors' leaders argue that the new surgeries will destroy the relationship between patients and their GP family doctor and force them to travel much further to see a doctor.

GPs are also worried that polyclinics could "cream off" younger, healthier patients who help to subsidise their practices to treat those with more complex medical problems.

But ministers insist that the clinics, which could house up to 25 GPs as well as extra services such as dentistry and minor surgery and will open during evenings and weekends, will provide a "world class" service.

The Tory research reveals that 608 practices in almost half of all Primary Care Trusts outside London -where ministers insist that the "GP led health centres" will be in addition to existing services - have already been listed as close to proposed new clinics.

If this were replicated across the rest of the country including the capital as many as 1,700 practices could be under threat.

The Tories said the implication was that polyclinics would threaten the viability of the practices listed, even if not all of them would be forced to shut.

Andrew Lansley, the Conservative health spokesman, said: "The Government needs to explain why these GP surgeries are being named if it's not because polyclinics pose a threat to the local doctor.

"It adds to the huge weight of evidence now building up that polyclinics are not the additional services as Gordon Brown has claimed. Patients and family doctors are right to be worried about losing a valued local service. It's time Labour faced up to their concerns and called a halt to their unpopular polyclinics scheme."

A spokesman for the BMA said that the publication of the list would worry GPs already concerned that their practices could shut.

He said: "We have always had concerns about the viability of practices that are close to these polyclinics.

"It is inevitable that they will lose resources because of the new development, even if they are not actually dragged into it.

"Ben Bradshaw [the Health Minister] has said that some patients won't have to deregister with their GP to use this service, but that is not really the point.

"There is only one pot of money and if it is all going into polyclinics then GP surgeries will have to cut back on services and many could be forced to close."

He added: "GPs who find themselves on this list will be even more concerned than they were already."

An official spokesman for Mr Bradshaw said: "There is no suggestion from any of those PCTs that these surgeries are marked for closure."

Within London, where ministers insist plans for polyclinics differ from the rest of the country, around 100 practices have already been already earmarked for closure, to make way for the new surgeries.

From:
Polyclinics-threaten-600-GP-practices%2C-say-Tories.html

A million patients battle against polyclinics

More than one million patients have signed a petition protesting against plans to close hundreds of GP practices to make way for polyclinics.

The signatures, collected by the British Medical Association (BMA) in just three weeks as part of its "Support Your Surgery" campaign, was presented to Gordon Brown at Downing Street.

The BMA is concerned that the new clinics will destroy the relationship between patients and their family doctor

The labour government cannot afford to ignore the level of patient concern over polyclinics, which have been dubbed "supersurgeries", doctors' leaders will say.

Ministers insist that the centres, designed to house up to 25 GPs under one roof along with other services such as minor surgery, will provide a better service for patients.

But the BMA claims they will destroy the relationship between patients and their family doctor and lead to more private companies running surgeries.

Analysis by the Tories suggests that 1,700 of the 8,700 GP practices in England could have to shut under the plans.

Around 100 GP practices in just eight PCTs in London, the first part of the country to roll out the policy, have already been earmarked for closure to make way for polyclinics.

Doctors will protest against the plans at the BMA's Local Medical Committees annual conference today, entitled "standing up for General Practice".

Dr Laurence Buckman, chairman of the BMA's GPs Committee, will tell GPs at the meeting that the petition "will deliver a stark message to the Prime Minister" about the true level of patient concern.

Dr Buckman will also say: "My message to Gordon Brown is this: Whatever you think of GPs, take note of what your electorate thinks. Work with us to improve the service, not against us, and ignore at your peril the wishes of the most important people in the NHS – the patients."

He will tell GPs : "If the government won't listen to you, their doctors, then surely it will listen to the 1.2 million men and women who call for a halt to the plans to promote the use of commercial companies in general practice.

"Voters don't want funding to move from GP practices to commercial companies who are accountable primarily to shareholders rather than patients. They want to be treated as patients, not customers."

The petition calls on ministers to "continue to support our existing NHS GP surgeries" and "improve services to patients by further investment in existing GP surgeries".

But Neil Bentley, from the Confederation of British Industry (CBI), accused doctors' leaders of "ostrich-like denial" and said that the plans would extend opening hours and increase the range of services offered to patients.

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A-million-patients-battle-against-polyclinics.html

Polyclinics 'will hit most vulnerable'

Closing GP surgeries to replace them with "polyclinics" will hit the most vulnerable members of society and damage the fabric of local communities, David Cameron said.

The Tory leader warned that Labour's plans for health care could lead to the closure of one in five GP surgeries around the country.

Mr Cameron said local residents should have the final say on whether surgeries should be replaced and urged GPs to fight the changes, signing up to a petition opposing the planned reforms. Polyclinics, conceived by Lord Darzi, a health minister and consultant surgeon, will combine GP services with nursing and social care on one site.

The Government insists they will create more choice for patients and greater access to specialist care.

Opponents fear they will leave some patients with long journeys and destroy the personal relationship between patients and family doctors. In a speech to a health think-tank in London, Mr Cameron said amalgamating as many as 1,700 GP surgeries would damage the fabric of local communities.

He said: "Labour has already tried to bring about the end of the district general hospital. Now they are trying to abolish the family doctor service. Communities which have lost their post office, their local shops, their local police station, are going to lose their doctor."

People including the elderly, those with small children and those with long-term conditions would be worst affected, Mr Cameron said.

"Those are the people least able to get to a polyclinic, and least comfortable in a large impersonal institution. They like to rely on the doctor they know, at the end of their street, often in a building not much bigger than a house," he said. "They have a human relationship with their GP that they simply won't have with a member of staff at a polyclinic."

Instead of "imposing" the clinics on communities, Mr Cameron said ministers should make the changes subject to binding local consultation. He said: "Where they occur, they should occur naturally, as the voluntary combination of free agents, not as the latest structural reorganisation of the NHS.

He also urged GPs to join an independent campaign against the polyclinics plan. The petition, drawn up by the think-tank "2020health" in consultation with the Tories, calls general practice the "foundation of the NHS" and says doctors object to "being forced into polyclinics against our will".

The petition also includes a demand for freedom to determine surgery opening hours.

"We want to work in partnership with GPs, not in conflict with them as this Government is doing," Mr Cameron said. "So I urge GPs to sign up to this petition and ensure that the next Conservative government has the backing of the profession to modernise general practice in a way that works for the staff and patients of the NHS."

Alan Johnson, the Health Secretary, last night accused the Opposition of backing a "free-for-all" that would end a recent agreement for more surgeries to open in the evenings and at weekends.

"This is an astonishing admission by the Conservatives. They are now supporting a free-for-all on opening hours which would see an end to the evening and weekend opening which has just been secured," he said.

"Far from diminishing primary care services we are enhancing them, but it seems that the Tories are more interested in ingratiating themselves with certain elements of the profession than they are in improving access for the public."

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/04/22/nclinics122.xml

Health Direct points out that every new major spin that labour dreams up tend to turn to ashes- just remember tough on crime, tough on the causes of crime.......

One in five GPs surgeries faces closure in polyclinic plans

One in five GP surgeries in England is set to close, threatening to end the era of a family doctor in every neighbourhood, an analysis of NHS plans reveals.

Labour government proposals to create a new generation of polyclinics will lead to the closure of 1,700 practices, the Tories claimed. In their place will be a series of "super-surgeries" housing up to 25 GPs and offering hospital-style outpatient appointments, minor surgery and pharmacies. While ministers hail this as a vision of 21st-century health care, opponents fear it is the death knell for traditional patient-doctor relationships.

David Cameron claims that the traditional GP surgery is at risk and only the Conservatives will save it.

The Tory leader delivered a speech to the King's Fund, an independent foundation working for improved health, on the future of primary care as the next stage of the party's "NH-Yes" campaign. It aims to reposition the Conservatives in the centre ground and seize the health agenda from Labour.

Health minister Lord Darzi, personally appointed by the Prime Minister to oversee the introduction of polyclinics as part of a major reorganisation of the NHS in England, has said 150 will be needed in London alone.

The Government insists they would create more choice for patients, offering GP, nursing and social care in one place. They would offer extended opening hours, from 8am to 8pm during the week, and weekend appointments.

But critics say those with chronic conditions, who need to visit their GPs more often than the typical patient, want the continuity of seeing the same family doctor.

Having fewer surgeries would also mean elderly patients who rely on public transport would have further to travel to see their GP. In London, patients would have to travel an average of 1.5 miles to reach their nearest polyclinic, according to the Government's own figures.

There are 8,261 GP practices in England, including 1,546 in the capital. Tory research, based on the Department of Health's estimates, shows that 1,701 surgeries in England face closure. Some 1,091 in London may go – nearly three-quarters of the total. In the rest of the country, 609 – almost one in 10 – could close in the next few years.

The research is based on the average number of GPs per practice in each primary care trust, and assumes each polyclinic would be staffed by 25 GPs.

According to a poll in Pulse magazine, eight out of 10 GPs are against the blanket introduction of polyclinics, warning it will dilute the personal relationship between doctor and patient.

The British Medical Association says it risks commercialising primary care as more services are contracted out. Just 8 per cent of GPs believe their local area needs a polyclinic, according to last month's poll. One in three GPs said they would refuse to work in a polyclinic.

Dr Laurence Buckman, chairman of the BMA's GP committee, said the Department of Health had shown little thought on how the local health service would be affected. He added: "Rather than being forced to create polyclinics, PCTs should be encouraged to invest in their local GP practices and support collaboration between practices.

"What works in London is unlikely to suit the needs of a rural community."

Andrew Lansley, the shadow Secretary of State for Health, added: "The Government is pushing ahead with forcing polyclinics in areas where they may not be needed. We are not against the idea in some places, but not at the expense of the local family doctor and patient care. Continuity of care for patients is at risk if their local doctor is closed.

"Patients will have further to travel and will be lucky to see the same doctor twice. The current relationship between GP and patient is one built on respect and trust, for the Government to wilfully destroy that is unforgivable."

Last year Mr Cameron launched a campaign to save the NHS, pledging a "bare-knuckle fight" with the Prime Minister over plans to close maternity and A&E wards in local hospitals. It ran into controversy when some of the 29 district hospitals the Tories said were under threat complained to the party.

But aides say the "NH-Yes" strategy will be centre stage of the next Tory general election campaign. They claim Mr Brown is planning a series of "NHS cuts" – language borrowed from Labour attacks on Conservative management of the service. They warn thousands of nursing jobs, hospital beds and acute wards will go under restructuring plans.

Lord Darzi produced an interim report on the NHS overhaul last November. A full report on the plans is expected in June. According to the minister's vision, patients will be able to see a doctor more quickly, possibly without an appointment, collect their prescriptions, get their eyes tested and see a physiotherapist all in the same building.

Ministers argue that the traditional family doctor of the 1940s, epitomised by the 1960s TV series Dr Finlay's Casebook, does not suit the modern needs of the NHS. Super-surgeries will include services currently only offered in hospitals such as minor surgery, diabetes screening and sexual health clinics, as well as access to traditional GPs and practice nurses.

But critics fear polyclinics will attract large private companies who can outbid local GPs. Union leaders accuse the government of privatisation by stealth and are planning to fight the moves.

GPs fear for their relationship with patients, claiming polyclinics will employ more salaried doctors who are unlikely to stay and work in one place for as long as partners in a local practice, many of whom spend a lifetime attached to one surgery. And while younger, "healthier" people are most concerned about easier access to doctors, patients with long-term conditions such as diabetes, asthma and depression, place greater value on seeing a doctor they know.

Dr Anthony Halperin, chairman of the Patients Association, warned last week: "We are concerned the personal contact with a GP will be lost within a polyclinic because another layer of treatment is being introduced."

Chronically ill patients and the elderly, who are the biggest users of GP services, would prefer to wait a day and see a doctor who knows their history, argue patient groups. And older and disabled people could be unwittingly excluded from the new clinics because they are too far away and difficult to get to.

The British Medical Association has written to Lord Darzi warning against a blanket introduction of polyclinics across the country. But ministers have reportedly told primary care trusts that they have no choice in backing a polyclinic in their area, even if there is already a large health centre nearby.

Another concern is that the £12bn NHS IT system which has already been plagued by delays and technical glitches is not designed to meet the needs of polyclinics.

The NHS Confederation, which represents local health service managers, said in a report published last week that the IT system would make it difficult to share patient information between primary care, social services and the independent sector. Sharing information across a range of departments is essential for polyclinics to work.

However, the NHS Confederation director of policy Nigel Edwards said there had been a "knee-jerk" reaction to the proposals. He said: "While it may sound like the polyclinic system will not resemble the service currently provided by family doctors, in reality it should build on what is best in general practice."

http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/struck-off-one-in-five-surgeries-faces-closure-812177.html

GPs could face fee if patients use A&E

Family doctors GPs could be charged when their patients go to accident and emergency units if they could have been treated at the local surgery.

The move - aimed at giving GPs an incentive to provide longer opening hours while reducing inappropriate use of casualty and minor injury departments - is being considered as part of Lord Darzi's "next steps" National Health Service review, due for publication in the summer.

The Department of Health confirmed yesterday that it had commissioned the NHS Confederation and NHS Employers to examine how a tariff, or fixed price, might be introduced for visits to walk-in centres, minor injury units, and for treating temporary residents. A draft report from the two bodies was being examined, it said, after the Health Service Journal disclosed the proposal.

David Stout, director of the confederation's primary care trust network, said GPs were paid to look after patients on their registers, but when alternative services such as walk-in centres were created "arguably that duplicates what general practice is already being paid for, so we end up paying for it twice".

NHS Employers have examined the system in New Zealand. Chris Ham, professor of health services management at Birmingham university, says patients there are charged for each GP visit, but the government can claw back money from family doctors if patients use other facilities, such as casualty departments, for what should be primary care.

The double incentive - that GPs lose both a consultation fee and face a clawback if patients go elsewhere - "means that it is very easy to get to see a GP on the same day or the next day. GPs are open for quite long hours, as they lose money if patients go elsewhere".

Dr Laurence Buckman, chairman of the British Medical Association's family doctors' committee, attacked the idea as unworkable. "Charging back costs if patients went to A&E or elsewhere would not be an incentive, it would be a punishment and work as a disincentive [for family doctors] to work in areas with high A&E use."

Dr Michael Dixon, chairman of the NHS Alliance, a primary care grouping, said the idea might work where GPs held budgets, were responsible for commissioning care, and could thus shape services.

Applied in other cases, the risk was that funding for the most important part of general practice - handling chronic disease and long standing illnesses - could be cut if penalty payments were imposed where "worried well" patients, or those with very minor conditions used other facilities inappropriately.

Meanwhile, with political and health service opposition to the idea of "polyclinics" rising, the NHS Confederation has called for calm in the debate. Polyclinics would group GPs around facilities that could include X-ray, blood tests and other "one-stop shop" facilities, while bringing more out-patient and antenatal work out of hospitals. They have led, however, to fears that patients would have to travel farther to see a GP.

From:
http://www.ft.com/cms/s/0/f11d4ff0-0c16-11dd-9840-0000779fd2ac.html

GPs set to lose income guarantee

The minimum income guarantee for family doctors is set to be scrapped, in a move that could open up health services to more competition.

A recommendation to scrap the guarantee is to be made by Lord Darzi’s “next steps” review of the NHS.

The move has been widely expected, as primary care trusts complain that the guarantee can double their costs when they introduce new primary care providers – but then have to continue to pay existing GPs a minimum income, even if large numbers of patients leave an existing practice.

“We would definitely like to see it go, and we have said as much to Lord Darzi’s review,” said David Stout, director of the NHS Confederation’s primary care trust network.

Lord Darzi’s report, expected in June, is still at early drafting stages. But one health minister said: “I would be very surprised if this does not happen.”

The Minimum Practice Income Guarantee, which costs about £300m ($592m) a year, was the result of a last-minute change to the GP contract in 2003 which pushed more money into payments for achieving quality targets, but paid GPs less per patient they took on.

As a result, some practices faced big potential drops in income. To get the contract through, ministers promised that no practice would face a lower income from the new deal than under the old one.

However, the effect of the guarantee has been to perpetuate historic inequalities in funding between practices, say both the NHS Confederation and the British Medical Association.

It also reduces the impact of payments that give GPs more money for taking on patients with greater needs – a formula intended to reflect workload and help those in deprived areas.

“The guarantee undermines the principle of fair funding,” Mr Stout said. “And it undermines choice to some extent because GPs can lose a lot of patients from their list but still get the same income.” This also discouraged primary care trusts from bringing in new providers because they would still have to pay existing GPs a minimum income, he said.

Dr Laurence Buckman, chairman of the BMA’s family doctors committee, said it too had little enthusiasm for the guarantee. “We would like to see it phased out over time,” he said.

Putting the cash into basic payments for GPs would work for many, Dr Buckman said. But a proportion of practices, perhaps 10 per cent, “would be such serious losers that many of them would probably have to close”.

Mr Stout acknowledged that “getting rid of the guarantee overnight would cause a lot of disruption. But we do need to find a way of phasing it out”.

http://www.ft.com/cms/s/0/fd9f8c38-0753-11dd-b41e-0000779fd2ac.html

Patients told- only one illness at a time, please

Family doctors have put up signs in surgeries banning patients from discussing more than one ailment per appointment.

The aim is to hurry along consultations so that GPs can meet government requirements to offer patients appointments within 48 hours.

Doctors argue that appointments run behind schedule when they are confronted with the “worried well” reading out lists of sometimes frivolous medical complaints, often researched on the internet.

The Department of Health condemned the restriction and said it should be withdrawn. It said GPs, who earn an average of £110,000 a year in England, were paid enough to make time to listen to patients who have more than one illness.

The department advised patients who encountered the restriction to complain to their local National Health Service trust: “There is record investment going into GP practices and the public who pay for the NHS rightly expect the service to respond to their needs and concerns.”

The Royal College of General Practitioners acknowledges that the restrictions are widespread. It is aware of surgeries putting up notices saying, for example, “One appointment, one problem, remember others are waiting” and has advised its members to take them down.

Sunday Times reporters found the restrictions in operation in Islington, north London, and Deal, in Kent. A member of staff told a patient at the Queen Street surgery in Deal that she should seek a second appointment if she had more than one ailment. The surgery could not be reached for comment this weekend.

James Whitticase, a GP in Poole, Dorset, said he disagreed with the policy and that patients should be allowed to raise all their ailments because they may not know which one is the most serious.

“A classic example would be a patient saying, ‘I have a rash on my neck, I have an ingrown toenail, etc, etc and, oh, I also have crushing chest pain’. We obviously want to focus on the chest pain but that is how patients sometimes present their illnesses,” Whitticase said.

“If patients are only allowed to discuss one issue, they may say the illness that is really bothering them at the moment is their ingrown toenail.”

Critics of the policy also point out that the role of the family doctor is to care for a patient’s health in general and not focus on single conditions.

The British Medical Association defended the restriction signs: “If they try to cram too much into one appointment it doesn’t work well for either the current patient or the later patients who may have to wait.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3736238.ece

Gulf in health between rich and poor widens under Labour government

Health inequalities between rich and poor have widened since Labour came to office in 1997.

A report published shows that attempts to narrow the gaps have largely failed. In infant mortality and life expectancy, two important measures, the gap is wider now than it was then.

David Sinclair, head of policy at Help the Aged, said that the figures made a mockery of labour's attempts to tackle rising inequality and represented a staggering failure.

“The starkest demonstration of the gap between rich and poor can be seen in the gulf in life expectancy between different social groups. Despite the Government's commitment that no-one should be disadvantaged by where they live, the reality is that people who are poor, or who live in poor communities die earlier” he said.

In 1995-97, the baseline for the life expectancy comparison, the average man had a life expectancy at birth of 75.1, while for those in the poorest areas it was 72.7 - a gap of 1.9 years. By 2004-06, life expectancy had risen on average to 77.3, but for the poor areas it was 75.3 - a gap of two years.

For women, the gap grew even more quickly. It was 1.4 years in 1995-97, but had risen to 1.6 years by 2004-06, an 11 per cent increase.

For child mortality, the gap has also widened, the report admits. In 1997-99, the baseline for this target, the average rate was 5.6 per 1,000 live births, while that for the poorest groups was 6.3, a gap of 14 per cent. By 2004-06, the average had fallen to 4.8, while the poorest group had reached 5.6, a gap of 17 per cent.

Cancer deaths showed no significant change in the gaps between rich and poor, but in heart deaths there was a widening in relative terms.

Other targets, such as under-18 conceptions, deaths in road traffic accidents, the number of GPs per 100,000 people, smoking prevalence and smoking in pregnancy, also show no change or widening gaps.

The sole exception among the health targets came in flu vaccinations, where the gap narrowed.

In her introduction to the report Dawn Primarolo, the Health Minister, claims to see “some signs of progress” but Sir Michael Marmot, chair of the scientific reference group on health inequalities, is more frank.

In his preface, he writes: “We are of the firm belief that there should be two central aims for health policy: improve overall health and reduce inequalities. The evidence shows success in the first but, as yet, not in the second, despite the welcome improvement in the health of the worst-off.

“It is simply too early to say if too little has been done or the right actions were not taken” he concludes.

Norman Lamb, the Liberal Democrat Shadow Health Secretary, said: “Widening health inequalities have been Labour's most shameful NHS failure. For the past decade, this Government has delivered little more than broken promises on reducing health inequality.

“Too much vital investment has been wasted on organisational upheaval and top-down bureaucracy.

“The terrible truth is that people from poor backgrounds and those unable to act as strong advocates for their own health continue to die younger and have a worse quality of life than the population as a whole.”

Dr Michael Dixon, chairman of the NHS Alliance, said that better primary care was the key to reducing inequalities. “Health Minister Lord Darzi's coming review of the NHS needs to focus on how primary care can lead the health service” he said.

“In particular, it must support strengthened practice-based commissioning, where local clinicians who know their patients make decisions about the services they need. That is the best way for the NHS to play its role in tackling health inequalities.”

Mr Sinclair said: “It's vital that targetted initiatives are developed to tackle rising health inequality - action is urgently needed to ensure better and more equitable access to GPs and preventative health care services.

“All too often, poorly served communities are poorer communities - leading to a cycle of disadvantage and poor health. Gaps in NHS provision have a direct impact on health inequalities.

“Without action to tackle health inequalities the Government's entire ageing strategy will be in jeopardy.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3552767.ece

Health Direct is saddened but not surprised by the waste that labour's decade of death has brought to the NHS. If you have a vote next month, please use it and remember the false lies about labour's 24 hours to save the NHS.

GPs win legal fight over pensions cap

Patricia Hewitt acted unlawfully when health secretary by capping the pensions of family doctors after they earned more from a new contract than expected, the High Court has ruled.

GPs retiring between 2004 and 2006 had their pensions capped after earnings from the new contract rocketed and ministers argued they had to cap pensions to protect the taxpayer.

However, Lord Justice Mitting yesterday ruled that ministers had no power to impose the limit, which was an attempt "to renegotiate an arrangement that had already been determined".

Dr Hamish Meldrum, chairman of the British Medical Association's council, said: "We are delighted that the BMA has been vindicated in its decision to challenge the government."

Doctors looked to the government to honour the deal, he said. The BMA said the cap had so far affected about 3,000 retiring GPs who had lost around £3,000 a year in pension. But the health department said the estimated long-term saving from the cap was £600m.

Mr Justice Mitting awarded the BMA its costs but gave Alan Johnson, the current health secretary, leave to appeal.

Lawyers for the health department argued the scale of the increases risked diverting resources from patients and were "indefensible".

Ministers acted after GPs performed far better than expected under a new performance-related contract, with average earnings comfortably clearing £100,000. Ministers were also angered GPs took more of their practice earnings as profit in the early years of the contract.

However, Dr Meldrum said there was "a very important principle at stake, which is that when the government makes agreements it should stick to them".

From:
http://www.ft.com/cms/s/0/45ac7808-f168-11dc-a91a-0000779fd2ac.html

Health Direct points out that labour's attempt to claw back funds from doctors is a direct result of their incompetent renegotiation of GPs contracts in 2006.

NHS IT delays hit cash savings

The potential savings from the £12.4bn NHS's IT project in England have been hit by delays dogging key parts of the programme, the labour government admits.

Officials said a prudent estimate from data from a fifth of NHS trusts showed it was on course to save £1.14bn. They said the figures were positive but acknowledged it could have been more.

The Tories said the savings were peanuts compared to the scale of the project - it is the biggest civilian IT scheme in the world.

Central parts of the 10-year programme - aimed at linking more than 30,000 GPs to nearly 300 hospitals by 2014 - have been running up to two years behind schedule.

Electronic medical records and "choose and book" - an online appointments system for GPs - have been the worst-hit.

Despite the problems, labour said £208m had been saved by March 2007, mainly because of the broadband network installed across the NHS and the progress made with the digital imaging and scanning.

And it predicted that by the end, the savings would top £1bn.

The figures were revealed in the government's benefits statement for the National Programme for IT.

Ministers were told to publish the accounts by the House of Commons' Public Accounts Committee in a report last year criticising the progress being made.

The document shows that the project has under-spent by over 40% so far.

This indicates the scale of the delays as suppliers are only paid when they deliver, although officials warned this could not be interpreted as exactly over 40% of project falling behind schedule.

Richard Jeavons, a senior IT official at the Department of Health, said: "We can be positive about the evidence emerging. Of course, if we had not had delays we would be further ahead."

But shadow health minister Stephen O'Brien criticised the fact only £208m had been saved so far, calling it "peanuts" compared to the cost of the programme.

"It is certainly nothing the government should be crowing about as it is the very least they should be doing to recover their incompetence on a grand scale."

From:
http://news.bbc.co.uk/1/hi/health/7295116.stm

Health Direct points out that labour's meddling, incompetence is beginning to come home to roost.

On March 20, 2006 Health Direct posted: NPfIT NHS plan is evolving but one-size-fits-all is a fundamental flaw, says hospital chief when Sir Jonathan Michael, a top NHS executive, who spoke at a healthcare symposium at London's City University pointed to a fundamental flaw in the NHS's IT-driven modernisation.

The flaw Michael sees in the National Programme for IT (NPfIT) is its centralised, standardised approach at a time when the health service is decentralising. The chief executive of Guy's and St Thomas' NHS Foundation Trust, Michael wants IT support for the specific ways people work in particular parts of his organisation, such as the accident and emergency department.

"The idea that the requirements for all hospitals are the same is, I think, simplistic. Flexibility is designed out of solutions and out of the implementation process. So standardisation of IT systems effectively dictates the standardisation of the business model," he said.

Michael's speech about the NPfIT commanded the rapt attention of his audience not simply because he is running one of the largest NHS trusts in the UK but because it is rare for any senior health service executive, especially one of Michael's standing, to criticise openly the NPfIT.

Caring for some cancer patients, for example, requires joint decisions being made increasingly in multi-disciplinary teams. Video conferencing is key to that, said Michael, but the original plans for the NPfIT did not set aside money for video conferencing.

Contract was a windfall for GPs but ‘not a good deal for patients’

The controversial contract to improve GPs pay and efficiency cost £1.76 billion more than the labour goverment expected and NHS productivity has actually fallen, a damning report by auditors concludes. The findings, by the National Audit Office, show that GPs who run their own practices received huge pay rises while giving up responsibility for the 24-hour care of their patients.

But GPs employed on salaries gained very little, while practice nurses actually saw a real-terms decline in pay. Hoped-for gains in productivity did not occur: productivity fell two years running, by an average of 2.5 per cent a year.

The costs of the contract were partly covered by extra cash from the Department of Health, but the primary care trusts who pay GPs were not fully reimbursed. As a result, they had to find £406 million between 2003-04 and 2005-06 from their own resources, limiting their ability to improve services.

The NAO report does not openly criticise anyone for the outcome, which enriched GP partners at the expense of almost everybody else. But when pressed, Karen Taylor, director of health at the NAO, said: “I think as far as the public and taxpayer is concerned, the benefits they should have been expecting to see have not materialised to the extent they should have done. From their perspective, it’s not a good deal for them.”
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There were some positives, she said. Recruitment and retention of GPs had improved, and the focus that the new contract brought on long-term conditions, such as diabetes, had helped patients. The average general practice appointment was longer — twelve minutes rather then eight — largely because an increasing proportion were being dealt with by nurses.

But NHS managers from top to bottom are found to have failed, by allowing the British Medical Association to negotiate a contract that enriched some of their members, shortened their hours and used up so much cash that reforms to services were stymied.

The report says that in its “business case” to the Treasury justifying the contract, the department had quoted figures that underestimated its actual cost by £1.76 billion over three years.

There were three reasons, Ms Taylor said. The department underestimated how much GPs would earn from the quality and outcomes framework, which rewards them for the number of quality points they earn; it underestimated the cost of switching out of hours responsibilities to primary care trusts; and it underestimated what it would cost PCTs to administer the contract.

GP practices are paid a gross sum, out of which the partners pay the cost of running the surgery, including salaries of nurses and other working doctors. The partners share the profits.

Perhaps the most damaging aspect of the report is the figure showing what partners did with their increased payments. They boosted their own incomes by 58 per cent over the three years, to an average of £113,614 in 2005-06. Salaried GPs whom they employ gained just 3 per cent in the first two years, to £46,905, while the average practice nurse’s income reduced in real terms, the report says.

The NAO concludes that one reason the contract has so far failed in the redesign of services is that the BMA negotiated a minimum practice income guarantee (MPIG), which ensured that no practice would earn less under the new contract than it did under the old. It meant that GPs retained the benefits of the old contract where it suited them, while gaining greatly from the new one. MPIG should be phased out, the report says.

Tim Burr, head of the NAO, said: “There is no doubt that a new contract was needed and there are now 4,000 more GPs than five years ago. But in return for higher pay, we have yet to see real increases in productivity.”

Laurence Buckman, chairman of the BMA’s GP committee, said it was meaningless for the audit office to talk about productivity because the way GPs worked had changed. “Productivity should be measured in improvements in health, not the frequency of consultations. The early evidence is that the contract is leading to improvements in clinical care,” she said.

http://www.timesonline.co.uk/tol/life_and_style/health/article3449057.ece

On February 07, 2008 Health Direct posted:Alan Johnson scraps with GPs over pay and opening hours

The 2004 general practitioner contract which the labour Government is now messily trying to unpick set a new benchmark for ineptitude by the Department of Health, whose weakness in contractual negotiations is legendary.

The agreement gave family doctors lavish salary increases tied to various incentives based on preventative health measures. In its first year it led to an average salary increase of 23 per cent, in the second year 10 per cent - an extra £30,000 a year in total.

A&E patients die waiting for ambulances to meet labour targets

Seriously ill patients are left for hours in ambulances instead of being immediately admitted to accident and emergency departments to meet a labour Government target on treatment times, it was claimed.

The practice of "patient stacking" has left some waiting for up to five hours because A&E units have refused to admit them until they can be treated within the four-hour time limit.

Unison, the public sector union, said the practice poses a danger to other patients because ambulances detained as "waiting rooms" cannot answer new 999 calls.

Mary Maguire, a spokesman for the union, said: "This happens time and time again. It is an appalling waste of resources. We should not use ambulances as waiting rooms.

"A 16-year-old terminally ill cancer patient died after waiting over an hour for an ambulance to transfer him. Three ambulances could have reached him but they were tied up waiting to hand over patients to A&E."

Dr Steve Field, the chairman of the Royal College of GPs, called the situation ''entirely inappropriate and unacceptable".

Evidence of patient stacking is revealed in the official ''turnaround time" data released by seven of England's 11 regional ambulance services.

The figures show that over the past 15 months at least 44,000 delays were reported by the ambulance services. In some cases the delays were up to five hours.

Norman Lamb, the Liberal Democrats' health spokesman, said the situation represented ''a scandalous distortion of practice to meet a target that is meant to improve the service".

Mike Penning, the Tory shadow health minister, said: "Not admitting people to hospital but stacking patients in car parks beggars belief in the 21st century."

George Alberti, the Department of Health's national director for emergency access and service design, denied the claim that Government targets are putting pressure on A&E staff to resort to patient stacking. He said: "The four-hour clock for A&E waiting starts 15 minutes after the ambulance arrives, regardless of whether the patient has been handed over."

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/18/nhealth218.xml

Alan Johnson scraps with GPs over pay and opening hours

The 2004 general practitioner contract which the labour Government is now messily trying to unpick set a new benchmark for ineptitude by the Department of Health, whose weakness in contractual negotiations is legendary.

The agreement gave family doctors lavish salary increases tied to various incentives based on preventative health measures. In its first year it led to an average salary increase of 23 per cent, in the second year 10 per cent - an extra £30,000 a year in total.

The deal pushed average GP salaries well over the £100,000 mark and some are earning twice that. One senior doctor who took part in the negotiations says the GP side of the table were stunned by the generosity of the DoH's offer - they thought it a "bit of a laugh".

The joke was not shared by patients. The deal focused on the producer, not the consumer, interest. Under the new contract most GPs gave up emergency cover - at a "price" of just £6,000 off their newly inflated salaries, who wouldn't?

Meanwhile, too many surgeries continue to open at hours that suit health practitioners but which are wholly inimical to the requirements of the working population and, to cap it all, in many practices the appointments systems remain hopelessly inflexible.

This triumph was the handiwork of the then Health Secretary Alan Milburn. His successors, Patricia Hewitt and now Alan Johnson, have struggled to amend it in a way that will give patients a more tangible benefit from the outlay of such large amounts of taxpayers' money.

In the process, there have been hints that GPs are being greedy. In reality, it would have required self-restraint bordering on saintliness for doctors' negotiators not to have grabbed what the DoH was offering with both hands. And as Dr Michael Ingram points out, conscientious family doctors more than earn their salaries.

The latest Whitehall attempt to amend the deal comes in the form of a letter from Mr Johnson to all GPs urging them to work longer hours. They are squabbling over an hour a week. The British Medical Association has already agreed to an extra two hours a week but the Government wants three. Battle lines are now drawn.

Given that ministers have only themselves to blame for this dispute, it is hard to avoid the suspicion that there is now a rather more sinister agenda being played out here. By appealing directly to GPs, the labour Government seems determined to break the influence of the BMA (just as it is seeking to cow other professional bodies such as the Police Federation) on the basis of divide and rule.

Such tactics are dangerous. While there may be some public disquiet at how well Britain's 42,000 GPs have done out of this deal, in any dispute between them and the labour Government, the public will instinctively be more sympathetic to their family doctors. Ministers should stop being so belligerent as they struggle to clear up a mess of their own making.

http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/02/05/dl0501.xml

Ministers back GP plan that sidesteps contracts

Family doctors face working unorthodox hours in so called super surgeries under a radical pilot scheme that could turn into a nationwide blueprint for medical care.

Ministers have given their backing to an initiative in Birmingham that is seeking to sidestep the controversial GP contract by encouraging doctors effectively to reapply for their jobs.

The project has angered the British Medical Association for seeking to corral GPs working alone into multi-doctor health centre "franchises" that would have set standards, longer opening hours and offer services ranging from x-rays to mental health advice.

"The idea that you can franchise health care and put health service workers in a uniform franchise like McDonald's sounds so ridiculous I cannot believe anyone would consider doing this," said Laurence Buckman, chairman of the BMA's GPs committee. "Working evenings and weekends . . . is the only thing that matters to Gordon Brown."

The Heart of Birmingham Teaching Primary Care Trust's corporate franchise strategy suggests the model could eventually allow private providers, such as "Virgin, Tesco or Asda", to quote the document, enter the market for GP services.

Managers are unable to force GPs to give up their single-practice surgeries. But they believe making doctors sign up to franchise agreements - overlaid on their existing contracts - will make them extend opening hours and offer more services, which would be easier to achieve in a bigger surgery. Doctors who opt out would face intense competitive pressure from other surgeries, managers believe.

The initiative may give the labour government a way to meet its pledge to increase out-of-hours care without having fully to renegotiate controversial GP contracts that gave family doctors a sharp pay rise through incentives that tended to shorten opening hours.

Health officials are closely monitoring the Birmingham scheme to see whether it can be used as a nationwide model. Ben Bradshaw, health minister, said: "Improving the quality and flexibility of GP services is a priority for the public. I applaud initiatives such as Birmingham's to respond to the views and needs of the local community."

From:
http://www.ft.com/cms/s/0/13fa0aac-ac42-11dc-82f0-0000779fd2ac.html

Health Direct notes that this is the same Brown Mr Bean that negotiated away the need for doctors to work weekends in the first place.

On January 31, 2007 Health Direct posted BMA team 'stunned by GP contract' as a bit of a laugh

GPs were so stunned by the terms offered to them when negotiating their new contract in 2004 that they thought it was a "bit of a laugh", a doctor has said.

Dr Simon Fradd, who was one of British Medical Association's GP negotiators, said they were shocked by the approach taken by the labour government. They could not believe it when GPs were given the chance not to do evening and weekend work for only a 6% pay cut, he said.

Tony crony Lord Darzi's health review targets GPs and MRSA superbugs

Lord Ara Darzi, Health Minister and author of the interim report on the NHS says that every patient who stays in hospital will be screened for the superbug infection MRSA and at least half of GP practices will open on Saturday mornings or one or more evenings per week.

Tackling infections which can be acquired both in an outside of hospital, is a key theme of Sir Ara Darzi’s interim review of the NHS in England.

Nurses will be required to swab all patients admitted for planned and emergency procedures, to test for life-threatening infections which could put other patients at risk. Those with positive results will be placed in isolation and given creams and body washes to clear the bugs.

Lord Darzi, a Health Minister and part-time surgeon, is conducting a review of services across England and Wales and also aims to improve patients’ access to their local GPs. Gordon Brown and Alan Johnson, the Health Secretary, attended the launch of an interim report on his review in London.

The report was published amid claims by campaigners and opposition MPs that it had been brought forward for publicity purposes amid mounting speculation of a snap election. Doctors and Opposition parties accused the Government of using the NHS as a “political football”.

Lord Darzi's study sets out how local Primary Care Trusts could work with new and existing GP practices to ensure greater flexibility on opening hours.

Family doctors have come under fire in recent months after nine out of ten decided to “opt out” of providing care on evenings and weekends.

Lord Darzi announced today that the Government’s aim was that at least half of all GP practices would open on Saturday mornings or one or more evenings per week.

A total of 150 GP-run health centres that open seven days a week, 8am to 8pm, will also be established in prominent locations around the country.

In addition, more than 100 new GP practices with up to 900 GPs, nurses, and health care assistants will open in the quarter of primary care trusts with the poorest provision, he said. The aim is to improve the health of people living in deprived areas.

Under measures aimed at tackling hospital bugs, all