Tonight:
14°c
Teenager becomes the first person to die of swine flu in London and the fourth in the country
More...
Seven out of 10 London doctors don't work outside office hours
03.03.08
Seven out of 10 GPs in London fail to offer "commuter-friendly" appointments, the Evening Standard can reveal.
In some areas up to nine in 10 refuse to open outside office hours.
A survey of doctors' opening hours shows there is a postcode lottery over access to treatment in the evenings and weekends.
The majority of GP practices only open between 9am and 5pm and many shut at lunchtime. Our survey found:
• In some boroughs, including Camden, no practices open on Saturdays.
• The worst borough is Kingston, where only one out of 29 open late and at the weekend (three per cent).
• In Greenwich, no surgery stays open late and just 15 per cent offer early morning or Saturday clinics.
• In Hackney, 35 per cent of practices open late or at weekends, compared with 44 per cent in Ealing.
As a result, thousands of patients have to take time off work or even visit accident and emergency units to get treatment.
The findings come as GPs are arguing with the Government over plans to force them to offer later appointments.
Last week, a National Audit Office report revealed that doctors have more than doubled their pay but are working seven hours less a week. The average GP's salary is now £110,000 a year - a rise of nearly a third in two years.
Today, the Patients Association warned that patients are being denied proper treatment by the "geographical straitjacket" over GP opening hours.
Spokeswoman Vanessa Bourne said: "I know of people who've had to take half a day off work just to sit at home to get an appointment, let alone the appointment itself.
"It's very unfair because you have no option about who your GP is unless you go private. If the service is rotten where you live, you can't just go to a doctor on the other side of London."
Health Secretary Alan Johnson wants GPs to work an average of three extra hours a week per 6,000 patients. The British Medical Association says this arrangement is too rigid and is offering two more hours for every 6,000 patients, but at more flexible times.
Dr Laurence Buckman, chairman of the BMA's GPs' committee, said: "Soon there will be a national arrangement for extended hours.
"Because of the way the Government plans to enforce this, it may not suit everybody and will inevitably infuriate patients because of the rigid way GPs will have to offer it. Please don't blame the GP, though - he or she will be doing their best to provide a good service within the straitjacket the Government has made for them."
The BMA will this week announce the results of a poll of its members on the issue. Whitehall insiders say they are "hopeful" that frontline GPs will support the new package.
The Standard's survey was based on the opening hours of 365 doctors surgeries, almost a quarter of all those in London. Primary care trusts in nine boroughssupplied data on how many practicesopened outside "core hours" (8am to 6.30pm) and on Saturdays.
The Londonwide Local Medical Committees, which represents GPs, said the survey was limited and insisted many doctors already offer extended hours. In Barking, for example, seven in 10 offer evening and weekend appointments, it said. Dr Stewart Drage, head of the LMC, said: "Many practices across London, including Tower Hamlets, Lewisham, Islington, Barnet and Harrow, offer early morning/evening clinics outside of core hours.
"The recent national survey of patients found 86 per cent are happy with their GP service...most of the capital's patients are successful in getting an appointment when they need one."
"Our patients tell us they're happy with our hours. The demand for extra hours is negligible."
The surgery, which has five GPs and opens from 8am to 6.30pm Monday to Friday, has 6,700 people on its books and is open to new patients. Dr Garsin said: "The original pay deal was needed to attract more GPs into the profession and it worked. We are now on a comparable scale with accountants and solicitors and that was long overdue.
"The pressure we're being put under is demoralising young GPs. It's going to make recruitment much harder. When older GPs start retiring we're going to end up back at square one."
'We open later because it's about patients, not money'
The Tudor Lodge Health Centre in Southfields is one of the few London surgeries where GPs are planning longer hours.
The practice opens between 8am and 6.30pm and on Saturday mornings. It is preparing to offer appointments until 7.30pm.
Practice manager and partner Prash Thurairatnam said: "We do more hours than we have to, even though there's no extra money, because as far as the doctors are concerned, it's not about money - it's about patient care. We have 6,000 patients and many of them work in town and couldn't get to a doctor without upsetting their boss. We are the only practice in the area that doesn't shut at lunchtime. Our phone lines are open the whole time and people can have a 10-minute consultation with a GP who can prescribe medication over the phone."
The practice, which has three GPs and two practice nurses, scores between 79 per cent and 98 per cent for patient satisfaction.
'We closed Saturday surgeries due to lack of demand'
Doctor Mitch Garsin believes the demand for extended hours simply does not exist among patients. He criticised the Government's attempts to strong-arm GPs into accepting a renegotiated deal.
The family doctor, with over 20 years' experience, said Saturday surgeries at his Belmont Medical Centre in Hillingdon had to be closed because there were not enough patients.
Dr Garsin, 48, said: "It's extremely disappointing the way the Government is treating GPs. It saddens me that a caring profession such as ours is being bullied and portrayed as greedy.
"I'm probably working harder now, seeing more patients and spending longer with them, than ever before."
Reader views (6)
Here's a sample of the latest views published.
As a GP myself I have to say I'm appalled at some of the comments regarding Londoners access to primary care. If true it does look like a lot of Londoners do have real issues with accessing primary care. The answer as Dr Shenton states isn't a simple knee jerk "make them stay open longer" but rather that the existing contractual requirement to offer service from 8.00 am to 6.30pm needs to be enforced by PCTs.
Have people having difficulties with access approached their surgeries to ask them to improve or make suggestions regarding telephone systems etc? Many surgeries run patient forums where patients make suggestions regarding the running of the practice.
I would suggest that people having difficulty with access make a complaint to their surgery in writing. This will trigger an investigation and formal response.
- Djm, Parbold UK
Commuter appointments?! I just wish I could make any appointment at all. Call surgery at 0830. Engaged tone on every attempt until 0910. Then told all today's appointment slots have gone. Is it an emergency? No. Try again tomorrow. And the day after. And the rest of the week. Until either one gets lucky, or it becomes an emergency when one's drugs are about to run out.
- Nigel, London
The political appetite for access to health care is insatiable. The current discussion regarding extended hours has largely been manipulated into a political argument by the government who are embarrassed by GP's hitting every single target agreed by both parties when the national contract was renegotiated. The central issue should not be allowed to be an hysterical vote pandering knee jerk reaction of increasing access, which does not mean quality, but making sure that existing practices offer a quality service during reasonable hours i.e from 8am to 6.30pm, as do accountants, solicitors, MP's, teachers, architects and most other professions. The non clinical aspects of general practice have increased exponentially over recent years and it is simply impossible to provide extended surgeries, with direct patient contact, throughout the day 8 till 8, 6 days a week. Audits, appraisals, planning meetings, prescribing meetings, educational gatherings, private study, dictation, committees etc are also very important. Most of us went into general practice because we wanted continuity of care and I regularly do 13 hours days ( as do lots of other people ) in order to preserve that. I have absolutely no problem with that whatsoever but to be told to work even longer hours is insulting, morally repugnant and clear evidence that the current daytime service is being devalued at a time that it should be embraced for the success it actually is for the vast majority of the public.
- Dr Paul Shenton, Hounslow Middlesex
Majority of GPs are overpaid and under worked. If the economy has been deregulated, why should GPs from changing work practice? GPs are supposed to provide value for money, but unfortunately, they do not.
- Philippa, london,uk
Hooray for the government for taking on the GPs - so many surgeries offer a terrible service to the public. Our GP surgery in Battersea only takes appointments on a Monday. My husband had a small infection but could not get an appointment at our doctors surgery for over a week - the end result was that the infection had deteriorated so much that he had a three night stay in hospital and surgery under a general anaesthetic. I wonder if the government should also look into the number of patients on GPs books - I believe they are paid by the number they have rather than by hours spent serving the public. This is encouraging surgeries to add too many patients for the service and time they can offer
- Jenny M, London
The government's campaign to manipulate the public via the media seems to be working well! As they can't sort out the mess and lack of morale on either side for patients or GPs, they want to sit back and watch the show,rather than dirty their own paws, as patients and GPs argue it our via various newspapers. A post code lottery.... some conveniently left alone and brushed under the carpet areas struggling to join the 21st Century, delight in being able to use different GPs via out of hours, as they have more confidence in that service, as collective complaint is ignored, causing at times bypassing of fully funded, but substandard services, over stretching nearest casualty units and stressing families to the max. Health Commission findings going back years need more than being filed in date order. Out in the sticks there is more potential for being told to shut up. Lets look closely at the areas where people CAN'T have a choice of GP practice.
- Maryfoordbrown, suffolk coastal
