Family doctors are to be issued with new contracts next week which will require them to guarantee that patients are given a surgery appointment within 24 hours.

Family doctors are to be issued with new contracts next week which will require them to guarantee that patients are given a surgery appointment within 24 hours.

Doctors' leaders have resisted the move as unrealistic but Alan Milburn, the Health Secretary, in an interview with the Independent on Sunday, said it was "unacceptable" that sick people should have to wait days, or even weeks, before seeing their doctor. "It will be the biggest shake-up in the way that family doctors are employed since the NHS was founded in 1948," he said.

The guarantee to have a surgery appointment with a nurse within 24 hours or to see a doctor within 48 hours is to be written into new "core" contracts being published this week for family doctors. The pledge will be phased in over the next three years for GPs opting to move to new personal medical services (PMS) contracts which allow doctors more flexibility in the way they provide care. NHS Direct, the telephone hotline, will be used to handle calls to ensure that GPs provide 24-hour cover.

Most of Britain's 30,000 GPs, who earn £50-£60,000, are currently paid by a complicated system of fixed fees linked to targets and the numbers of patients on their lists. Ministers, who want to encourage GPs to spend more time with fewer patients, believe that within four years most family doctors will move to PMS contracts to relieve themselves of the burden of red tape and running practices as private businesses.

Mr Milburn is negotiating with the BMA to ensure that all other GPs guarantee an appointment with a practice nurse within 24 hours, and to see the GP within 48 hours. The PMS core contract will also require GPs to spend 30 hours a year improving their skills.

The Health Secretary is unwilling to compromise on key proposals outlined in the NHS national plan in July. "I am confident that the alliance of doctors, nurses, unions and royal colleges that put the plan together will stay in place to see it implemented," he said.

But he warned that the changes could take years to deliver real improvements in parts of the NHS and could not guarantee that no patients would be left waiting on trolleys this winter.

The Government has allocated £600m extra this year to cope with winter pressures, but Mr Milburn damped down expectations raised by higher health spending. He said: "There can be no instantaneous transformation in the NHS. It will take time to feed through.

He set out five priorities for the autumn: establishing a new NHS board to oversee the changes, with patients' representatives; appointing a new NHS executive; launching a new strategy for reducing cancer rates; setting national standards to end the "postcode lottery" of care; and allocating three-year budgets so health authorities can plan for growth.

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