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Vote no to this deal that patients don't even want

I think it is clear the Government and its advisers do not care a fig about the medical profession. I suspect doctors are viewed as troublesome and too independent. I feel there is probably also a slightly messianic horror that GPs may speak with an authority that is not dependent on the Government.

GPs have been slow to recognise ministers' malevolence. We have a situation now where we are expected to absorb the rising cost of practice staff while carrying out Government- or PCT-driven work with no increase, or indeed a decrease, in funding.

GPs voted for their new contract in 2003. I, and many others, asked GPC members about the clause allowing the Government to change this contract with just 13 weeks' 'consultation'. My concerns about this were, I felt, brushed aside.

Older GPs may just want to hold their breath for retirement. The prospect for younger GPs is chilling.

If GPs accept the Government's suggested offer for this April then I think a wedge will be pushed further in for 2009 and GPs will be in an even weaker position.

Don't say you weren't told!

From Dr Paul Meadows, Bristol

The Government wants extended opening hours and in particular late evening opening. But the idea is misguided, will not achieve what is intended and may even prove harmful to patients. We should know - we have 24 years' experience.

Twenty-four years ago we looked at the problem faced by patients who did not want to have to take time off work to consult their GP. In order to accommodate this most deserving group, we changed the time of our evening surgery (an open-access session), extending it for an hour and adding an extra appointment session between 7pm and 8pm on four weekdays.

We did not achieve what we intended - far from it. Over the years, few needy workers have availed themselves of the opportunity we created specially for them. Many have been surprised to learn about our late evening appointment session. Many have then surprised us by electing to come instead to a normal surgery.

Why? It turns out that patients prefer to come to their GP during working hours (their employers' time) rather than forgo their planned social activities. Which, of course, explains the quietness of surgeries between Christmas and New Year.

From Dr Bernard Newgrosh (GP) and Margaret Young (receptionist), Bolton, Lancashire

I have given considerable thought to the impact of the imposed extended hours contract, and have looked at the legislation regarding equal opportunity and particularly sexual discrimination.

Has anyone thought of the position of the whole practice team, who would have to work extra hours, rather than just GPs? Has anyone considered that nearly 100% of practice nurses and reception staff are female? I would also suggest that many of them are parents who have taken jobs in general practice with consideration of school times and provision of nursery care, and that they cannot work past 6.30pm and at weekends.

So when we try to get these staff members to work until 8pm and at weekends (when childminders are not available and schools not open) are we not being forced to breach legislation on the basis of the disproportionate impact on one sexual group?

Interesting! Could this be the basis of the legal challenge the GPC is looking for?

From Alan Moore, practice manager, Ellesmere Port, Cheshire

Am I missing something? I naively thought a contract was a legally binding agreement between two parties (the Government and GPs in this case), which could not be varied without joint consent.

I believed we had agreed to work 08.00 to 18.30 Monday to Friday. Now we have been told the Government is unilaterally going to change the contact and that if we don't accept its first offer, we will get an even worse one imposed on us.

A contract like this isn't worth the paper it is written on. Surely the BMA should be seeking legal advice or, if we have no redress, the negotiators who signed it on our behalf should hang their heads in shame. It feels as is we are no more than puppets with the Government pulling all the strings.

From Dr Anne Dyson, Chelmsford, Essex

'It is important that the BMA does not put the interests of its members ahead of the interests of patients', according to health minister Ben Bradshaw.

It doesn't look too bad when you say it quickly, but consider. The BMA is a trade union. The prime function of any trade union is to put the interests of its members first, as any Labour MP knows very well.

The amazing thing is that the BMA, in my experience, always considers the interests of patients and frequently puts them ahead of those of its members to the extent that many firebrand doctors resign in disgust!

Politicians on the other hand put themselves and their party interests first. Look at the New Year message from our chief politician, which announced - without consultation, planning or evidence - that patients would be offered instant health checks, including us screening for abdominal aortic aneurysm in the surgery at any time.

And who wants to subvert proven QOF activity and resources into access out of hours? Access is currently sexy and vote-winning, whereas evidence-based preventive care is so last year.

'If you tell a lie, make it a big one', as the Nazis used to say. Folk are less likely to notice. But sometimes they do - and they remember.

From Dr Lewis Miller, Belfast

One of the great difficulties that will arise with extending opening is differentiating between routine and emergency work. This is highlighted by Dr Susan Bowie's comments ('Should GPs accept the Government deal?', News, 9 January).

We all would want to help someone at any time with a life-threatening condition such as melaena, as Dr Bowie suggests, but this is not what is intended.

The extended opening is for non-emergency work - emergencies will still be dealt with by the current out-of-hours 'care', which in this area normally means being sent to A&E.

Who can blame patients for wanting some decent out-of-hours care? But this is not what is being proposed.

The Government may yet regret its lack of transparency on this matter when things become clear. Doctors certainly will.

From Dr Jeremy Phipps, Market Deeping, Lincolnshire

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