GP opening: Reinventing the wheel?

Some GP practices are already open in the evening and at weekends

Extended opening hours for GPs. Sounds familiar? It should.

The last Labour government encouraged practices in England to open later in the evening and at the weekend - offering them extra money if they did so.

Most GPs gave it a go. But the problem was that in many places there was just not the demand, and so the funding was reduced and hours cut.

There are still plenty of surgeries that offer out-of-hours appointments, particularly in large urban areas.

But the truth is that the people who are most likely to make use of the service - those that work - are the least likely to need a GP.

Elderly people and children - are the most frequent users of primary care services - tend not to have a problem attending appointments during regular hours.

That is one of the reasons why at the start of Andrew Lansley's time as health secretary the amount of funding available to practices wanting to open for longer was reduced.

It was cut from about £3 per patient per year to under £2.

Unsurprisingly, it resulted in a drop in the number of GPs opening in evening and weekends.

A&E problems

Another scheme that has somewhat withered away is the network of seven-day-a-week health clinics. These were known as Darzi Centres after the minister who came up with the concept and over 150 were planned for England.

The idea was to offer both a walk-in centre for everyone and a GP service for those wanting to register with them.

But again the appetite among patients was somewhat limited and a number have now closed.

So after all this why are ministers now talking about extended opening again?

The simple answer is the sands have shifted.

Last winter's A&E problems have meant that ministers have to be seen to be taking action before the weather turns cold again.

One of the criticisms of current arrangements is that patients do not have many options when they need help once their surgery doors are shut.

By opening for longer, the hope is that some of the A&E visits that are not emergencies can be dealt with in the community.

But the new scheme is pretty small scale at the moment. There will be nine pilots covering about 500,000 people when they are all up-and-running.

The idea is to get groups of GP practices co-operating and sharing the burden of extended opening.

Again this sounds good in theory, but for those with long memories it too may be familiar.

Dr Richard Vautrey, a Leeds GP and senior member of the British Medical Association, explains: "When I got into general practice 20 years ago we were working in co-operatives to provide out-of-hours care - it was the way we covered nights.

"That doesn't mean it won't work. If it is properly resourced it could help. But there is a certain irony to it."