One of the frustrating experiences for politicians is to pass a law, or to issue a Ministerial edict, and then find that everyone just carries on as before. So some eye-catching scheme is launched but hardly anybody signs up for it. A bold target is declared – but then missed by a wide margin.

The Conservative Manifesto for 2010 declared:

“People want an NHS that is easy to access at any time of day or night. We will commission a 24/7 urgent care service in every area of England, including GP out of hours services, and ensure that every patient can access a GP in their area between 8am and 8pm, seven days a week.”

In some places this has become a reality. But the National Audit Office report this week found considerable variation:

“The GMS contract stipulates that ‘core hours’ are 8 am to 6.30 pm, Monday to Friday (equivalent to 52.5 hours per week). Practices do not necessarily have to be open throughout these core hours, but they must provide essential services at times to meet the reasonable needs of their patients. When they do close during core hours, the vast majority of practices report that services are covered by a local out-of-hours provider or neighbouring practice. We found variations in practices’ opening hours during this period. As at October 2015, some 46% of practices closed at some point during core hours. In particular, 18% closed at or before 3 pm on at least one weekday, despite three-quarters (76%) of these practices that closed receiving additional funding in 2015-16 to provide access outside of core hours. Our evidence suggests that the variation between practices cannot readily be explained by differences in their patients’ needs and shorter opening hours are associated with poorer outcomes. We found that patients registered to practices that are open for fewer than 45 hours per week attend accident and emergency (A&E) departments more often.”

“There are unexplained variations in practice opening hours,” the report adds. There have been too many incidents of “gaming the system” – for instance with surgeries nominally open at particular hours but patients not told about it.

This morning we learn that the Prime Minister is determined to tighten up the arrangements so that the GPs deliver the service they have been commissioned to provide. According to the Daily Mail:

“In a series of decisive measures, the Prime Minister will make family doctors meet their own pledge to stay open from 8am to 8pm, with no more of the two-hour lunch breaks or midweek half-day closing that we exposed on Thursday.

“Crucially, GP practices will lose lavish bonuses if they fail to advertise extended opening hours or don’t offer appointments when people want them. They will also be encouraged to let patients book consultations online.”

Already there have been critics of the announcement. The Shadow Health Secretary, Jon Ashworth, notes the pledge was in the 2010 Conservative Manifesto – all the more reason to ensure that it is delivered I should have thought. If the Government had just shrugged off the NAO report then he would have more of a point.

Then we have Professor Helen Stokes-Lampard of the Royal College of GPs, the grandly named trade union for family doctors. She says:

“It’s extremely unfortunate that the prime minister is being reported as pushing forward with a misguided scheme to force GP surgeries to offer routine services from eight to eight, seven days a week, regardless of patient demand or local resources. It is not the case that GP surgery routine opening hours are contributing to the pressures our colleagues in A&E departments are currently facing.”

Professor Stokes-Lampard does not explain why some of her members manage without a two hour lunch break while others regard it as imperative. Of course where people can’t see a GP it will increase the pressure on A&E departments – for her to claim otherwise is absurd.

What is welcome about the announcement is that in highlighting the variation in performance it offers an alternative way forward to the crude and unaffordable demands for ever more billions to be poured into a vastly inefficient, mismanaged monolith.