A newsletter for distribution among patients, explaining the value of GPs and the position they are in, will also be attached.

The GPC has rejected the DoH quality framework offer on the grounds that it will adversely affect the care of the most needy patients.

But with the only alternative being a tougher imposed deal, the GPC plans to poll all UK GPs on their views over the proposal in the coming weeks.

Under the current DoH offer, 58.5 quality points will be removed from holistic care, organisational and patient experience domains and devoted to extended hours and access.

Additionally, £158 million from the access and choice and booking directed enhanced services (DESs), which are due to end in March 2008, will be used to fund extended hours.

For this money, the DoH wants GPs to work an extra 30 minutes per 1,000 patients per week. The DoH has also offered a guaranteed 1.5 per cent increased investment in general practice.

If the GPC fails to agree, the DoH plans to impose changes, with money from 135 quality points and the access and choice and booking DESs to be put into the hands of PCTs to manage to ensure provision of extended hours. The average practice would be £36,000 worse off.

Prime minister Gordon Brown admitted this week that plans for extended hours 'may be controversial but we'll see it through'.

Dr Buckman said: 'We are disappointed and angry the government is not listening to GPs.

'We are being bullied so the prime minister can tick a box next to a politically driven target without regard for the damage this could do in the long-term to patient services in primary care.'

The GPC agreed to extending hours, albeit fewer, along with inclusion of targets for heart failure, osteoporosis and peripheral vascular disease, which were recommended by the expert review panel (see box).

GPC deputy chairman Dr Richard Vautrey said: 'The DoH doesn't see improving quality in these areas as important as achieving their targets around extended hours.

'With what it is suggesting, both with the offer and the imposition, it's clear the DoH is trying to take funding away from practices to fund its APMS project and the Darzi plan.'

The GPC is concerned that the push for extended hours over quality of care will ruin continuity of care, meaning that patients can see a GP at different times but they may not be able to see their own GP.

Health minister Ben Bradshaw said: 'The public would like to be able to visit their GP at times that are more convenient for them.'

View Dr Laurence Buckman's letter

The contract deadlock

DoH wants ...	GPC wants ...
Quality point changes
Change up to 60 points.	Change 38.5 points.
Reassign to access.	Reassign to new clinical areas.
Extended hours
£158 million from access and choice and book DESs.	£158 million from access and choice and book DESs.
Extra 30 minutes consulting per 1,000 patients per week.	Extra 15 minutes consulting and 5 minutes administration per 1,000 patients per week.
Patient surveys
Reassign 75 points for local patient survey.	Change 20 of 75 patient survey points to focus on access.
Create a national patient survey.	Retain the local patient surveys.

rachel.liddle@haymarket.com

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