The war of words over 7-day GP services
- Published
Talk to a GP and it wont take long for the issue of seven-day services to come up.
There are heated and varied opinions. Some argue forcefully that they have a heavy workload on weekdays so extending a full service to weekends is impossible.
But there are others, in groups of practices which already provide weekend opening, who wonder what all the fuss is about.
The Conservative pledge to provide access to GP services seven days a week for all patients in England by 2020 was made at last year's party conference.
It was repeated, along with the commitment to more extensive weekend hospital care, in the party's manifesto.
As if to underline the importance of the issue, David Cameron in his first major speech since forming a majority government in May again spelled out his vision: "a modern NHS working for you seven days of the week - when you need it, where you need it".
So what are the practicalities of the rhetoric? Its worth noting there is already seven-day primary care in place through GP out-of-hours services.
NHS weekend: Want to know more?
Visit the BBC's special report page on 7-day services (This link will not work on the BBC app but some of the key content can be seen below)
Some doctors who work at surgeries during the week also agree to join duty rosters run by out-of-hours contractors and they resent the suggestion that they refuse to work at weekends.
The 111 phone service is available 24/7, and is intended to direct people to the most appropriate care outside surgery hours.
Recruitment problems
The weakness of the existing system, though, was highlighted by none other than the head of NHS England, Simon Stevens.
In a speech this week he talked of an incomprehensible "alphabet soup" of overnight and weekend services.
He said patients were left confused as to whether to call 111 or out-of-hours GPs or go to their local A&E unit.
Increasing numbers of GP practices are linking up locally to provide weekend appointments for patients who want them.
This will probably not be at their local surgery but at one which is at least in their town or community.
Mr Cameron said in his speech that by the end of this financial year, 18m patients in England would have access to a GP seven days a week.
These existing seven-day GP access schemes tend to be in larger urban communities with a varied population and with practices clustered more closely together.
Doctors in rural areas have complained that there is no demand for weekend appointments and that local patients, often with more elderly in their number, are well served by 12 hour opening from Monday to Friday.
'Barely achievable'
The doctor's magazine Pulse reported in May that a weekend surgery opening pilot scheme in Kent had been scrapped because it was not taking the pressure off local A&E services.
The GP profession has faced recruitment problems and some doctors quitting because of what they argue is an unacceptable workload.
The Royal College of GPs has told the BBC that seven day a week, 12 hours a day routine general practice is "unachievable" in this parliament.
Serving patients over current opening hours was barely achievable with existing staff numbers according to the RCGP, never mind over weekends.
Health Secretary Jeremy Hunt says the government is committed to funding 5,000 more GPs by 2020, what he calls the biggest single increase in GP recruitment in the history of the NHS.
He told me that ministers were "absolutely focussed" on delivering seven-day services.
People should not have to take time off work, he argued, and potentially lose wages to see their GP during working hours.
The British Medical Association has, though, questioned whether enough new doctors can be found given the current recruitment problems and where the money will come from to pay the extra salaries.
This government will be judged on their pledges at the time of the next election in 2020.
Ministers believe seven-day services in general practice will be steadily rolled out across England and GP numbers will rise to meet patient demand.
But some in the medical world believe primary care is creaking at the seams and may fracture because of the workload.
They can't both be right.