Extended opening hours and GP surgeries on a Sunday? It must be election time – again

With opening hours back in the spotlight, PulseToday editor Steve Nowottny looks at the Conservatives' pledge to give patients routine GP appointments seven-days-a-week

It's taken just a week for GPs to be thrust into the centre of the general election campaign – and in a way which seems all too familiar.

Cast your mind back to May 2007, when Tony Blair was still PM and Gordon Brown launched his leadership bid, setting out his manifesto and daring any of the Labour party's heavyweight candidates to challenge him. The key, central plank of his bid? Extended hours access to GPs.

'If I can show how at weekends and outside the normal hours people can have more access to the health services they need, millions using NHS Direct, millions using walk-in centres, more access to GPs, then I believe that is what politics is actually about,' Mr Brown told his campaign launch.

‘Gordon Brown has placed GPs firmly in the firing line over access out of core hours,' Pulse reported, ‘while privately admitting he does not intend to tear up the GP contract.'

Now, of course, evening and weekend surgeries are a reality for many GPs – but the Tories have decided to up the ante, with an even bolder pledge. The central plank of their election manifesto, trailed in the national press over the weekend, is also improving GP extended hours access – and this time, wholesale renegotiation of the GP contract seems to be very much on the cards.

Details of how it will actually work remain sketchy, at least until the manifesto's official launch tomorrow. Patients are to be guaranteed access to a local GP – though not, crucially, their local GP – for routine appointments between 8am and 8pm seven days a week.

In practice, of course, some patients will already have this, through a GP-led health centre if not their own surgery. But the Tories' plans seem to go much further. Not every practice will be required to open seven days a week, but every practice will be required to commission cover. (The Tories suggest this could be from a GP cooperative, specialist provider like an ambulance trust, local hospitals or other practices).

Clearly 150 Darzi centres aren't going to be able to provide routine evening and weekend appointments for every patient in the country.

For the Tories, it's a nifty piece of politics. Ever since an interview with Pulse in April 2008, when he suggested scrapping the DES funding in favour of greater investment in the QOF, extended hours have given shadow health secretary Andrew Lansley a bit of a headache – not least because his words were quickly quoted back at him by Gordon Brown at Prime Ministers' Question Time.

GPs may wonder how a pledge to provide seven-days-a-week access to GPs squares with Mr Lansley's claim that ‘senior professionals providing a service who are accountable to patients should not have their hours controlled by Government' – but as an election issue on the doorstep, it's now one the Conservatives are now firmly on top of.

There's also the question of how GPs' work-life balance will really be affected. Sunday surgeries may seem a grim prospect – but the best thing about GPs being responsible for commissioning routine extended opening is that GPs will be responsible for commissioning routine extended opening. In other words, if you don't want to do evening and weekend surgeries in person, you won't have to. Could the Tories' proposals actually see fewer GPs having to work late into the evening or start work at the crack of dawn?

As ever, everything depends on the money. The elephant in the room when it comes to the Tories' plans to renegotiate the GP contract – which will also see GPs' handed responsibility for commissioning out-of-hours care – is whether the additional work this involves will attract new money, and how much money GPs will be given to spend. As yet, we simply don't know.

But however it's spent, it seems impossible that giving millions of patients access to routine appointments at evenings and weekends won't cost a significant amount of money.

In bettering Labour's pledge to improve GP access with the headline-grabbing commitment of Sunday surgeries for all, the Conservatives have effectively negated charges that their extended hours policy favoured doctors rather than patients. But at a time of across-the-board budget cutbacks throughout the NHS, BMA chair Dr Hamish Meldrum's charge that the plans are a ‘wasteful luxury' may be harder to rebut.