A radical shake-up of primary care to make GP surgeries more flexible and patient friendly, including the prospect of specialist GP surgeries for teenagers, is to be outlined today by the health secretary, Patricia Hewitt.
People could also register with GPs near their workplace rather than their home as a better reflection of modern lifestyles. Family doctors would also be given greater autonomy to order diagnostic scans rather than having to refer to a hospital.
Ms Hewitt today launches an ambitious public consultation on the plans - including citizens' juries, videos and town hall meetings - that will culminate in a white paper on "health outside hospitals" in the late autumn.
The health secretary will kick off the process in a speech that will suggest that public involvement in health services can help to counter the decline in trust in modern politics.
In an interview with the Guardian, Ms Hewitt denied she was bent on privatising GP services, pointing out that most are anyway independent self-employed contracted providers to the NHS.
Long concerned by the decline in voter turn-ut, she will claim that politicians have lost trust due to "an explosion in communications, the internet revolution, an end to deference and a society that places a premium on the authenticity of personal experience".
She will argue that politicians must start the process of "building democracy beyond the ballot box".
The health consultation may also reveal the extent to which the public regards the current regime of GP practices as failing to meet the needs of patients and their working lives.
The government has already indicated that more surgery, testing and diagnostics will be performed in primary care settings. In a bid to avoid a confrontation with an often conservative profession, Ms Hewitt is already holding sessions with GPs to hear how they would innovate.
Ms Hewitt said yesterday she expected the consultation would look into access to GPs' surgeries, including whether a patient can make advance and urgent appointments. She said patients should have a right to both.
Appointments became a general election issue when the prime minister was caught off balance during a BBC Question Time confrontation by a member of the audience who said she was unable to book ahead.
Ms Hewitt also promised to explore the decline in the number of GPs willing to provide out of hours services. The Guardian recently revealed that health recruitment agencies were making unsolicited advances to German doctors in order to fill the gap.
The health secretary said: "GPs had been saying with increasing force for some years now that they were not happy with the amount of out of hours work they were having to do. In response to that, the GPs contract was fundamentally changed by the Department of Health to give GPs the choice about whether they wanted to provide out of hours services themselves or whether they left that to the primary care trusts to organise for their patients.
"Most GPs don't want to offer the out of hours services themselves. We will be exploring that with patients, including the possibility of GP cooperatives."
She added: "In some inner city areas there are simply not enough GPs. It is very difficult even to get registered, or to get the quality of service the public need."
The health secretary said she was also keen to improve the connection between the NHS and teenagers. She said many young men were not registering, and some entrepreneurial GPs or nurse practitioners had suggested surgeries that specialise in teenagers.
She said she wanted to know how "traditional GPs would feel if they were no longer responsible for the whole family, and are they really caring for the whole family if teenagers are not using the service?"
The pressure to reform GP services comes as ministers battle to meet the ambitious target of all patients receiving hospital operations within 18 weeks of the first GP referral. By December this year GPs will also be asked to offer patients a choice of four or five hospitals.
"The more we can do outside the hospital, the more the patients prefer it, but also by and large you get better value for money," she said.
GPs should look at building their lists around patients' working environment, as opposed to their homes.
"How do we balance the continuity of care that patients and GPs value, and greater choice?" she asked.
She also expected the public to have "much to say" on greater flexibility around repeat prescription, adding that electronic prescribing will would help since a patient will be able to register a preference for a pharmacy with the prescription then go direct to the pharmacist. In more cases the pharmacist themselves could issue the prescription.
She said that once the patients' electronic record service was running, it would make it easier for the new walk-in centres and minor injury units to study a patient's entire records.
