Access to general practice in England: political, theoretical, and empirical considerations

1 outlined the historical context of current policy to extend practice opening hours in the evenings and at weekends. Campbell and Salisbury 2 examined the conceptual foundations of access to health care. Ford and colleagues 3 reported empirical work on patient preferences for additional opening hours, while Scantlebury and colleagues 4 modelled general-practice-level determinants of emergency department visits. We extend this discussion below, focusing on the UK government's controversial commitment for all patients in England to be offered GP appointments between 8 am and 8 pm, 7 days a week, by 2020. 5 POLITICAL CONSIDERATIONS Language used by the government when referring to its commitment to extend opening hours, in addition to that used for its wider political strategy, provides one means of analysing this policy. Relevant government press releases often refer to people with busy work and family lives who struggle to fit in GP appointments; the latest mentioned '7-day GP services for hardworking families' and offering 'hardworking taxpayers and families the security of care they need'. 6 In April 2015, at the launch of the Conservative Party manifesto for the last UK general election, David Cameron declared the Conservatives to be 'the party of working people'. 7 In October 2015, after being re-elected as Prime Minister, he repeated this position at the Conservative Party conference: 'The party of working people, the party for working people — today, tomorrow, always.' 8 The consistent rhetoric, highlighting a focus on the employed, is one sign that the policy to extend opening hours cannot be divorced from wider political activity. The timing, source, and place of the government's statements on this policy issue are also revealing. The Prime Minister, rather than the Department of Health or NHS England, has often made the major relevant announcements. These have taken place, for example, at the Conservative Party annual conferences in September/ October 2013, 2014, and 2015. The first commitment in the Conservative Party election manifesto read, 'We will continue to increase spending on the NHS, provide 7-day a week access to your GP and deliver a truly 7-day NHS.' 9 This highlights that the policy to extend opening hours is seen as a politically important issue — likely to win election votes and in keeping with the Conservative Party strategy to position itself as the party that most benefits working people. Such policy could face organised medical opposition, however, as with recent strikes against …