Leading article: Doctors, flexible hours and the real world of their patients

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The Independent Online

The Secretary of State for Health, Patricia Hewitt, used a conference speech in Harrogate yesterday to call for a "more patient-friendly" health service. High on the list of changes she broached was greater flexibility in GP surgery arrangements to accommodate the way people live. The opening hours of GP surgeries and booking procedures were, she said, among the greatest sources of dissatisfaction among patients.

The findings come out of a consultation exercise being conducted in advance of a White Paper, due for publication at the turn of the year. Whether it should have needed a full-blown consultation to uncover complaints overheard in ordinary conversation every day of the week is a separate question. But at least the fact has now gained top-level recognition: for a great many people, especially those who work full time, the hours of many GP surgeries make it difficult for them to see a doctor, let alone the doctor of their choice.

The problem is compounded by the continuing impossibility in many places of making advance appointments. This bizarre by-product of the Government's targets for waiting times has not been eliminated, despite its starring role in the election campaign earlier this year. Cancer and other screening procedures, family planning clinics and other services may also be provided at times or locations that have the effect of discouraging attendance by those in work. This may explain why, despite all the publicity, the percentage of women screened for cervical and breast cancer has fallen in the past two years.

As Ms Hewitt rightly stressed, the problem is not the service itself - satisfaction is high - but gaining access to it. Longer hours for GP surgeries, to include early mornings, evenings and weekends, is one solution. Another is that patients should be able to register with two surgeries, one near their work and one where they live. The wider provision of "drop-in" health centres in high streets, shopping centres or stations could also help.

Flexible services along these lines are being provided experimentally in some places. But they are still too few and far between. And cost is a real issue. This was the main objection raised yesterday by the BMA and individual GPs, who said that more doctors would be needed for the surgeries to extend their hours.

There is no reason, however, why more convenient provision should necessarily entail vastly more expense. The consultation exercise shows that many people resort to hospital accident and emergency departments out of GP surgery hours. This is an expensive alternative. Proposals for prescribing rights to be extended to nurses and pharmacists could also mitigate the cost of longer opening.

The outcry by the BMA over the prescribing issue, however, suggests that the doctors' reluctance to embrace this and other changes reflects a concern not just about cost, but about what they see as the erosion of their closed shop. The weakness for the Government here is that it has been sending mixed signals. Having recently agreed a new contract with GPs that gave them the right not to work unsocial hours - a change, we note, a majority embraced with alacrity - the Department of Health seems now to support more flexible working.

It is a great pity that this has not been the message from the Department of Health all along. At a time when flexible hours are required of an ever greater proportion of the work force - the professions included - there is no reason at all why doctors should be exempt.

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