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Feature Primary Care

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BMJ 2010; 340 doi: (Published 05 March 2010) Cite this as: BMJ 2010;340:c1154
  1. Nigel Hawkes, freelance journalist
  1. 1London
  1. nigel.hawkes1{at}

    Every primary care trust in England was told to set up an open access health centre to make seeing a GP easier but has it worked? Nigel Hawkes wonders

    England’s general practitioners took a risk in opposing the government’s call in 2007 for longer opening hours. It was a battle they were destined to lose, and one that might easily have threatened the long established pattern of primary care in the National Health Service.

    Gordon Brown had set his heart on making access to GPs easier. To achieve this (and despite assurances that a “top-down” solution was not envisaged) an England-wide programme of new health centres was imposed.

    All 152 primary care trusts (PCTs) were instructed to create such a centre. Confusingly, they were initially known as polyclinics, after the model devised for London by Lord Darzi. And the fact that any patient, registered or not, could walk in to them for treatment caused further confusion with the existing nurse led walk-in centres.

    What emerged was different from either. Now referred to generically as GP led health centres, their distinguishing characteristic is their opening hours, 8 am to 8 pm, seven days a week, 365 days a year. They provide access to GPs or nurses to anyone who turns up and also register patients like a conventional general practice.

    This cuckoo in the cosy nest of primary care has predictably drawn criticism from those who fear they may go hungry, or even get displaced. Running a general practice has been seen as a franchise for life, with all the advantages of private enterprise for those so inclined, crowned with a public sector pension on retirement. What’s not to like?

    Demands of 24/7 culture

    Plenty, in the government’s view. The 2004 general practice contract had enriched the doctors while allowing them to opt out of …

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