Richard Vize makes a sweeping dig at the British Medical Association and GPs, your traditional villains, and will probably get a quick laugh from the cheap seats. But has HSJ missed a point here?

The government's offer on extended hours offers GP practices a below-inflation 1.5 per cent uplift for an extra 30 minutes' opening per 1,000 patients. This 1.5 per cent has to fund not only the extra costs involved in running the practice, but also in-year inflationary costs, such as staff pay rises. This is an effective disinvestment in primary care (for the third year) - fair enough, you may say, but what will become of the primary care-led NHS?

Perhaps, more importantly, it marks a significant shift of investment from the quality and outcomes framework to extended access.

While the framework is far from perfect, it does represent performance-related pay for primary care, and there is now good evidence that it is driving health gain. It is one of the much trumpeted reforms in the new GP contract, which is now being abandoned. Whither NHS reform?

Results from a government-commissioned study show an 84 per cent satisfaction rate with GP access, and only 4 per cent of patients seeking evening access. How many other public services score so highly in the eyes of their users?

If decision makers had understood the workload and performance of hospital consultants and GPs before they negotiated the new contracts, it is unlikely that we would have had the current controversy surrounding the cost of the new contracts, or the difficulties over GP out-of-hours service.

Dr Michael Rooney, GP, Stockport

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