The imposition of extended hours was one of the bloodiest episodes in the recent history of general practice.
Ministers steamrollered GPs into accepting a DES funded only with recycled money from Choose and Book and access by threatening to otherwise slash 135 points from the QOF and deliberately delay payments to practices.
Negotiations had been so fraught that at one point the GPC raised the serious prospect of the profession quitting the NHS en masse.
The saga caused GP leaders lasting psychological damage, which has to some extent shaped their response to more recent crises, and continues to be a sore point for many GPs.
So the news that GP practices are now facing financial penalties over extended hours is likely to infuriate the profession.
We reveal this week that PCTs across the country are auditing ‘utilisation rates' of practices' extended-hours surgeries, and in some cases planning to dock pay if too few patients come through the door.
Some GP surgeries appear to have been left with little choice but to quit offering the service, sacrificing their slice of that recycled cash, because new PCT requirements for surgeries made them simply too onerous to run.
It is apparently in vogue to hold GPs to account for matters far outside of their sphere of control.
First practices were set QOF points that penalise them if too many patients turn up to A&E; now they face deductions in their pay if those same patients fail to turn up during extended hours.
The Government is convinced that there is a right and a wrong way for patients to access care, and if they get it wrong GPs get the blame.
Metropolitan elite
But it is particularly galling when GPs are held to account for low interest among patients in extended hours, because that was precisely the GPC's case against the scheme in the first place.
GPs have long criticised Government policy on access for being rigidly focused on the needs of the metropolitan and urban elite, without taking into account the very different needs of patients in small towns and rural areas across the UK.
Professionals in London, Birmingham and Manchester might well want extended surgeries, but was there ever a case that the good people of Buckingham or Wallingford wanted to see a GP at 7:30pm?
GPs raised just the same objections over the nationwide rollout of Darzi centres, arguing that they might fulfil a need in urban centres, but were always likely to be a waste of money in more rural areas.
As one by one Darzi centres close their doors, that argument looks won. But at least when unloved Darzi centres are forced to shut up shop, it is PCTs that pick up the tab.
When the punters shun extended hours, it is GPs who are being asked to pay the price.
That is more than just a cruel irony. It is grossly unfair, and must be resisted by
LMCs. Otherwise, this most unpopular of policies will be allowed to further extend
the pain.
