The government is promising a "new deal" for GPs in England - if they sign up to seven-day opening. In a speech on Friday, Health Secretary Jeremy Hunt will promise extra investment and help for under-pressure services. The package includes plans to recruit 5,000 new GPs and another 5,000 support staff, including practice nurses. Financial incentives may even be offered to those willing to work in the most deprived areas.

Those who have left the profession or want to work part-time will be given more help, Mr Hunt will promise. But he will say that in return, GPs need to get on board with his plans for weekend opening, which involves groups of practices pooling together to share the extended hours. It builds on plans set out at the start of this year for NHS England to make the profession more attractive as the NHS is struggling to recruit new doctors.

More than one in 10 GP training places remained vacant last year. A survey of more than 15,000 GPs by the British Medical Association before the general election in May suggested a third were considering retiring in the next five years and one in 10 was thinking about moving abroad. Mr Hunt will urge GPs to work with him. "I want to be upfront: this is not about change I can deliver on my own," he will say.

"If we are to have a new deal, I will need your co-operation and support. Within five years, we will need to look after a million more over-70s. Put simply, if we do not find better, smarter ways to help our growing elderly population remain healthy and independent, our hospitals will be overwhelmed."

Dr Chaand Nagpaul, of the British Medical Association, said GPs were "ready to work with the government". But he warned seven-day services may not be the right idea to push forward with. "Pilots of seven-day routine working are increasingly demonstrating a low uptake of routine weekend appointments," he said. "Therefore, to make the most of the limited GP workforce and precious NHS resource, the government should focus on supporting practices during the day and further develop the current 24/7 urgent GP service so that patients can be confident of getting access to a quality GP service day and night."

The government is promising a "new deal" for GPs in England - if they sign up to seven-day opening. In a speech on Friday, Health Secretary Jeremy Hunt will promise extra investment and help for under-pressure services. The package includes plans to recruit 5,000 new GPs and another 5,000 support staff, including practice nurses. Financial incentives may even be offered to those willing to work in the most deprived areas.

Those who have left the profession or want to work part-time will be given more help, Mr Hunt will promise. But he will say that in return, GPs need to get on board with his plans for weekend opening, which involves groups of practices pooling together to share the extended hours. It builds on plans set out at the start of this year for NHS England to make the profession more attractive as the NHS is struggling to recruit new doctors.

More than one in 10 GP training places remained vacant last year.

"If we are to have a new deal, I will need your co-operation and support. Within five years, we will need to look after a million more over-70s. Put simply, if we do not find better, smarter ways to help our growing elderly population remain healthy and independent, our hospitals will be overwhelmed."

One thought I did have is that making the mid-week service 8am-11pm might make more sense. The reason I find myself thinking this is that it makes sense to me to structure GP access in such a way that it makes early intervention easier and more likely.

It just seems to me that we've got to move our entire health culture (not just the NHS) away from short-term emergency treatment and towards well-being and whole-life care - emergencies tend to be a load more expensive. The trouble is how do you do that without harming the lives of doctors?

I think:
Separate the care of old age related illnesses from the general healthcare system and bring back old people community centres (maybe the care staff could be located in those rather than practices?) and community support staff.

I had typed my earlier reply about 0830 but it hadn't posted


Your employer should allow you to take reasonable time off for attending the doctors. The Tories don't like this - they want you working constantly. On the other hand, extended hours has shown access isn't always required. On top of this, the cost of running the surgery for longer isn't reimbursed in any way. A supermarket open for longer can generate more profit. A surgery open for longer will have more overheads but no increase in income to pay for it.


It's not just about livelihood. There's a lot more to it. The demand isn't there in most parts of the country. London is about the only place where it's really needed. But despite London not being representative of the country, what happens there still determines what happens elsewhere.

In our surgery, we have emergency walk-in available between the last appointment (1730) and when we close (1830). I'm on duty for one day a week and throughout a typical year, I might see five people who have walked in asking for an urgent review. Yet at another surgery I worked (largely commuter), we were seeing around 30 patients a day in the same time frame.


Where are you going to get the money from? Biggest problem. Most elderly people want to live in their own homes. They don't want to go into residential care or nursing care, where it might be more cost effective.

I had typed my earlier reply about 0830 but it hadn't posted


Your employer should allow you to take reasonable time off for attending the doctors. The Tories don't like this - they want you working constantly. On the other hand, extended hours has shown access isn't always required. On top of this, the cost of running the surgery for longer isn't reimbursed in any way. A supermarket open for longer can generate more profit. A surgery open for longer will have more overheads but no increase in income to pay for it.

In our surgery, we have emergency walk-in available between the last appointment (1730) and when we close (1830). I'm on duty for one day a week and throughout a typical year, I might see five people who have walked in asking for an urgent review. Yet at another surgery I worked (largely commuter), we were seeing around 30 patients a day in the same time frame.

It's not just about livelihood. There's a lot more to it. The demand isn't there in most parts of the country. London is about the only place where it's really needed. But despite London not being representative of the country, what happens there still determines what happens elsewhere.

I'm talking about community centres, not care homes.
i don't like the idea of just going for the cheapest option or plugging holes.
Surely it'd be cheaper in the long run than them being looked after by the practices?I believe a lot of older people ills are due to loneliness rather than poor health

In our surgery, we have emergency walk-in available between the last appointment (1730) and when we close (1830). I'm on duty for one day a week and throughout a typical year, I might see five people who have walked in asking for an urgent review. Yet at another surgery I worked (largely commuter), we were seeing around 30 patients a day in the same time frame.

Rusty, there isn't enough money, resources or staff for what you want, which is essentially 24/7 routine care. The entire health system was never set up for it. Even if you could get a routine GP service 24/7, you need everything else to be there - hospital specialties, pathology and imaging services, social services, district nurses etc. They all operate on a 9-5 routine service which makes it a complete pain in the backside when I've got a patient at 6pm who needs say a chest x-ray - they're not gonna get one till the next day.

Just to provide 12/7 access is an increase of something like 60% workload with (so far) no increase in funding, resources or staff.

Dear Mr Hunt,

Thank you so much for your kind speech detailing the new deal for GPs that you announced today. We have been waiting with baited breath to see what you would come up with. Well, you didn't disappoint.

You fulfilled all the expectations of vague headline filling promises - 5000 more GPs, 5000 other clinicians. I notice you sneaked Physician Assistants into that last bit with Pharmacists and Nurses, gently implying that they are a proper job with a role in the UK healthcare system. Nicely done. You kept a lid on the time-scale - clever. I'm sure we will have 5000 more GPs over the next 50 years, but it's minor detail.

You're going to market general practice to the best and brightest students. Smashing. What are you going to tell them? Is it the bit about not investing any more money in primary care? I think they'll like that. Is it the part about giving us data ("Data!!" I hear them shrieking in fevered excitement as they choose their careers), that will tell us which areas of the country are under-doctored? I'm always keen to save the Department of Health time and money - you have got to find £22 billion of efficiency savings after all. So get ready, the under-doctored areas are..... the whole country, apart from your constituency, which is why you don't seem to care about it. Job done.

So now we've attracted their attention, and I think you'll agree it's going well so far, you're going to tell them about the extra year of training they can do before they qualify are you? It's a lovely, lovely idea. Very similar to the one that the Royal College of GPs had a few years ago, but that was quietly shelved because it would slow down the number of new GPs coming through and would have made this whole recruitment crisis happen a bit earlier. Which would have looked pretty bad for the Government - which was you interestingly, wasn't it? Don't worry, rather than putting the extra year of training into general practice and killing two birds with one stone, you've put them in other areas, and delayed those doctors qualifying while in the middle of a recruitment crisis. If I was the doctor advising you - and I realise that is unlikely to happen - I'd have said:
"Jeremy, it's a delightful idea. But surgeries are closing because there aren't enough doctors. You want to add an extra year onto their training, and not even in general practice! Let's put that idea on the "long term aims to wheel out at the next election" shelf, and sort out where the hell we are going to get these 5000 extra GPs you keep promising."

You want these bright new recruits to come on a journey with you. To join a partnership in providing care. Hmmm. I like the financial incentives part - a bone of realism there, although I note the wording "explore the idea of offering financial incentives" keeps it non-committal. Bearing in mind that a scheme offering £20,000 golden hellos to new recruits in Leicestershire was ended after it failed to attract more than three doctors, you do need to listen when we say it isn't about the money.

You're doing a marketing campaign too - yippee! A few posters will do the trick. You're offering flexibility for part time GPs - I think that already exists, but nice try.

I can see a bit of investment in premises, and a programme to help struggling practices. All good, all good. A couple of top tips from the coalface though. Based on personal experience, NHS England's response to struggling practices is shocking. If you could get them to stop shrugging their shoulders and muttering about contracts, then standing by while the practice goes under, that would be amazing. Or stop them doing stupid things like making mystery shopper calls to neighbouring practices when 10,000 patients have suddenly lost their GP, wasting everyone's time instead of solving the problem, I think we would all be delighted.

There's another few mentions of giving us data - just let me contain my excitement again. Data to show that we are "providing the outcomes for the patients who rely on us most". Interesting wording. I read that as "more targets that take you away from seeing patients". You've got someone working with the CQC and NHS England on this, so it is guaranteed to go down well with jobbing doctors.

You want us to "respond to the needs of busy, working families" by offering seven day opening for routine medical care. Another big tick on reasons for those best and brightest to join us. You seem to have made all of the above, frankly underwhelming commitments, based on all practices offering seven day a week opening. A bright, magic new future for general practice.

The BBC published a poorly worded article on their news website this week, asking "Why are GPs so angry?" - there's been a lot of chat online about this, and let me share some a few replies with you, from working GPs across the country.

"The never ending increase in workload without adequate resources"
"Being told we do everything badly"
"Bureaucracy and over-regulation of everything we do"
"Feeling that despite trying my hardest and putting in far more than the public seem to think, I am letting my patients down. I just can't give anymore"

So Jeremy - we aren't a complicated bunch. All you needed to do was invest more in general practice - give primary care the 11% of the NHS budget it used to have, and we will solve the rest. Cut the bad press, because you know you can with a few phone calls to the right people. Ditch the pointless regulation and box ticking. Let us do our job. You still haven't realised how dire things are. No-one can recruit. It won't improve with this insipid panacea. Where I work, one GP training scheme has NO trainees next year. None. Another has a third of the places filled. The last one, only half.

This new deal? There's nothing in it that makes me hopeful, or makes me feel you understand what you are dealing with. NHS general practice is collapsing. To persuade any young doctors to go into it now, the carrot needs to be a whole lot bigger than the stick. So thanks, but no thanks.

On behalf of all hard-working GPs in the country,

Dr Zoe Norris.

‘The BMA is out of touch with what patients want.'