However, I fear it highlights the lack of appreciation shown by many people of the consequence of such initiatives on primary care.

I applaud his concern to improve access but access is one cog in the mechanism of primary care. To alter the size of that cog does not necessarily improve the total primary care package. This is the message that any GP will shout from the roof tops, not for their own benefit but for the future of primary care and the care of their current patients.

The government survey last year reported that 86 per cent of people were happy with the current opening hours. Michael, may I correct you. Current opening hours are suitable for the vast majority of patients, not as you stated, unsuitable.

There are two main issues that, though linked, are separate.
Firstly - The 8 to 8 centre. To satisfy its fixation that improving access will solve all primary care problems this government has decreed that a new surgery will be opened, in our case, likely to be in Doncaster Centre.

This new centre will be open for anyone to walk in with or without an appointment from 8.00am to 8.00pm. You will be able to see a doctor. He or she will not know you, not know your problems or background and not have your notes. The doctors are likely to be working shifts so, on any return visit, you will probably see another, unknown doctor. If this fragmented care is suitable for you, access to a GP is indeed increased. If you live outside Doncaster centre or do not have transport I suggest that it does not improve access.

Alternatively a patient will be able to transfer from their current surgery and register with the new practice. Again, this may give greater choice to town centre patients but do little for those in outlying areas.

To correct a misunderstanding from my first letter - there will be increased funding from the NHS to the Primary Care trust for this 8 to 8 centre.

Second issue is extended opening. GPs are being asked to open for an extra half hour for every one thousand patients on their list. This could be early morning, in the evening or on Saturday. The rules for this extended access have not been published yet. Most doctors are not averse to providing longer opening hours at times suitable for both patient and the practice - they are, however, concerned that the nationally imposed rules may not provide access that is in the best interest of the local population.

Some doctors may not provide this service feeling that seeing patients at the end of a busy, long day is not clinically safe, or that they would like to have some rest and relaxation at home with their families at weekends.

There are many current initiatives to improve access and choice for patients. These often duplicate services and, I suggest, this spare capacity does not represent a good use of resources.

Patients need to be aware of the balance between easier access and fragmentation of care. They need to be fully informed before they make their choice.

For further information about the future of healthcare in England click here to follow this link.
http://www.guardian.co.uk/commentisfree/2008/apr/29/nhs.health

Nic Burne
Chestnut House Surgery
The Vermuyden Centre