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Should general practices open for longer?

BMJ 2013; 347 doi: (Published 19 November 2013) Cite this as: BMJ 2013;347:f6832
  1. James P Kingsland, president 1,
  2. Peter W Swinyard, chairman2
  1. 1National Association of Primary Care, London W1G 9DP, UK
  2. 2Family Doctor Association, Heywood OL10 4NN, UK
  1. Correspondence to: J P Kingsland james.kingsland{at}, P W Swinyard peter.swinyard{at}

The government wants general practices to open longer for scheduled care. James P Kingsland says this will reduce pressure on emergency services, but Peter Swinyard thinks it is unaffordable in the current fiscal climate

Yes—James P Kingsland

General practices in England have too much unwarranted variation in opening times. Some already provide appointments in the early morning and into the evening. Some still provide list based weekend services. However, others have unacceptable waits, restricted opening, and even close for half days.

International evidence has established that health services incorporating a comprehensive system of primary care achieve better health outcomes and greater equity in health than systems oriented more towards specialty care.1 Health resources are also more efficiently deployed by strengthening primary care.2 But the triple aim of improved patient outcomes, improved patient experience, and improved value will not be achieved without increasing capability as well as capacity.1

Demise of out of hours care

The model of delivering primary care in England has been evolving since the inception of the NHS in 1948. A pivotal moment in this evolution was the renegotiation of the general practice contract implemented in April 2004. This allowed general practitioners to opt out of out of hours care and determined core contract hours for delivery to be from 8 am to 6.30 pm, weekdays only.3 Since then, urgent care provision has incrementally come under extreme pressure in all sectors of the NHS and access to routine appointments remains a national concern.

A central focus of the current NHS reorganisation is to find a remedy for the increasing demand on urgent care systems. Patients are increasingly using emergency departments for non-emergency care; more and more people are presenting for routine ambulatory care and sometimes with simple self limiting illnesses.

Some patients refer themselves to emergency departments when unable to see a GP …

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