The findings of the national patients experience survey this year revealed that high demand from patients for extended access, including Saturday mornings, simply does not exist.
Nevertheless, the government is pushing for extended hours, while GPs do not wish to run poorly attended extra sessions or foot the bill for higher overhead costs.
The DoH seems to have backtracked on transferring clinical quality points to an access domain in favour of a more appropriate incentive: funding extended opening through local enhanced services contracts (LESs).
Availability of LES cash would encourage some practices to open for longer, but it is one thing to add one or two 6pm-8pm surgeries on weekday evenings. But it is quite another, after five days of intensive work, to have your work/lifestyle balance hijacked by losing your Saturday-morning off-duty time.
Fifteen GPs told us how they felt about running Saturday morning sessions on a regular basis and, with one exception, they were all against the idea.
'Saturday a.m.? No thanks, I've just got my life back after 15 years as a GP,' says a GP in Huntingdon. This sentiment is echoed by an Exeter GP who says: 'It's wonderful to be without Saturday-morning surgery and have a full weekend off. I think it is essential in these pressurised days,' he says.
Another GP who practices in Leicestershire believes opening on Saturdays would be a complete waste of time. His practice has a 92 per cent access satisfaction rate, an elderly list and little demand for extended hours.
'I saw one patient per week on average when covering Saturday morning in the past and all of these could go to the local walk-in centre,' he says.
However, one Sussex GP argues that if funding was available to allow extra staff to be appointed, there is no reason why GPs could not offer extra access outside normal hours.
She says that extended access would be a new service because routine care has never been available out of hours and would have to be funded. She adds that there is little point in GPs working when no local support services are available.
Says a Berkshire GP who practices within commuting distance of London: 'Hardly any patients ask for a Saturday appointment and we have an excellent out-of-hours service run by GPs.'
He said the in-hours support services would not be accessible and that GPs' weekday workload has risen considerably. This doctor predicts that 'to start covering evenings and weekends will drive us to destruction; to divorce, drink, depression and suicide.'
Views like these suggest that imposing Saturday-morning opening on unwilling GPs must be generously resourced.
Reasons against weekend working
- Upsets the work/life balance for GPs and their staff and will have a negative impact on morale.
- Lack of demand from patients.
- Extra overhead expenses- greater energy use and higher salary bill, for example.
- Security issues: for example, staff safety in mainly empty premises.
- Support from local healthcare services not available.
- May reduce availability of GPs and staff during normal working hours.