• Accreditation
• Ambulatory care
• Anaesthesia

WHO regards access to primary care as a priority for all health systems, because of the benefits for population health and because of the changing nature of populations (more older people with chronic conditions) and the growing expectations of the public.1 In most developed countries, progress has been made in enabling people to use primary care services during routine office hours, and policymakers have begun to ask “how much access is enough”?

The two main drivers for extending access to general practices beyond traditional office hours are the possibility that longer opening hours would lead to reduced pressure on hospital services and the need for policy to respond to the pressure from patients for appointments with their primary care providers.

Difficulty in getting appointments in general practice is associated with higher use of hospital emergency departments,2 and evidence from a US study of extended hours in primary care indicates that extended hours can reduce the demand for care from hospitals. In a study relating to the years 2005–2008, a national sample of 43 484 people with a usual source of care, 77.5% reported their provider offered care in the evening and weekend.3 Total expenditure per patient was 10% lower, and there were fewer emergency department attendances, among patients reporting access to extended hours. Evidence from England on the potential effect of weekend opening of general practices is likely to be emerging soon, and professionals and policymakers in this country will soon have to decide how much access to primary care is enough. Their conclusions are likely to be of interest to the primary care services of other countries.

The effect of extended hours may be dependent on other characteristics of the healthcare system; for example, if the capacity of primary care is already stretched, extending opening hours will …