pounds 35-a-month for well-off to see doctors on demand

FAMILY DOCTOR services are to undergo the most significant development they have seen for years with the launch of a network of private GPs - not seen in Britain since the NHS began.

Over the next six months, health insurance company Private Patients Plan is to establish between six and 10 pilot schemes in the south east, where patients will be able to get consultations on demand.

The service will offer unlimited appointments lasting 20 minutes or more for a monthly fee of pounds 20 to pounds 35, depending on the patient's age and medical need. It is expected to have a "big appeal for better-off people", according to independent private health consultants Laing and Buisson.

The project is being launched at a time when there is growing frustration among both patients and doctors about the state of GP services. Practitioners are weary of trying to practise medicine within the confines of the eight- minute consultation, while patients are fed up with being told to wait days for an appointment.

The British Medical Association concurs. Dr John Chisolm, chairman of the GPs' committee, estimates a third of GPs could be interested in an alternative scheme. "The average eight-minute consultation means doctors have to tailor their service to the time available. It is understandable if some GPs feel they could deliver a better service if they had more time. They also feel underpaid and it would be understandable if some looked for new earning opportunities," he said.

The GP system is unchanged since it was launched in 1948, providing free medical care to all on the basis of need. But 50 years on, expectations have risen - and demands for change are growing. In place of a service based on need, some predict that in 1999 we will see increased growth of one based on what people want.

The trend to privatisation has already begun with a clutch of insurers attempting to break into the market for GP care. Currently 3 per cent of GP consultations are paid for privately, compared with 13 per cent of elective [routine] surgery - and much higher levels in London and the south east - suggesting substantial scope for growth.

Laing and Buisson write in their recent Health Care Market Review that 1999 could see the emergence of a "significant private primary care market for the first time in the UK".

The worry is how a scheme such as PPP would affect the NHS. GPs involved in the scheme would have to allocate their time between their private and NHS patients to avoid accusations of queue jumping. Arrangements would have to be made to to avoid duplication of treatment by the patient's private and NHS GPs, which could be dangerous.

The aim of PPP's pilot sites will be to determine the appeal of the scheme and the likely demand for consultations which will affect the level of the monthly fee. Dr Adrian Bull, medical director of PPP, says up to a quarter of the adult population could ultimately be interested in the service. "We believe it could develop strongly over three to five years. Its appeal is based on being able to see the GP promptly, having a stronger personal relationship and the opportunity of a longer consultation," he said.

But Dr Chisolm worries that growing private GP practices would be a problem for the NHS. "Although there is a lot of moaning about the NHS there is still great loyalty to it," he said. "If there was a significant shift towards private care then people might start to say why should we pay taxes for the NHS when we have opted out at a personal level?"

The most eloquent exponent of private GP schemes is Dr Brian Goss, an NHS GP and former BMA negotiator. Dr Goss argues that sufficient funds will never be forthcoming to raise the standards of the NHS to match the demands from a public used to the standards of the private sector.

He says: "Doctors believe in the NHS more than the electorate does. The electorate does not believe in central state provision. They would rather keep their money to themselves and choose what to buy with it."

PPP's GP scheme is modelled on its successful Denplan which provides dental cover for a fixed annual fee. But, as NHS dentistry has declined in quality and accessibility, the worry must be that NHS general practice would also become a second-class service.