Alan Johnson, the Health Secretary, has written to every GP surgery in England urging them to open in the evenings and at weekends. He wants surgeries to be open for an extra three hours a week. The British Medical Association (BMA) is only prepared to offer two extra hours. They say opening for longer would compromise patient care, unless they were given extra resources. The government's proposal would, apparently, only cover a single GP working late at the surgery, without a nurse.

The whole argument is ludicrous. Why do GPs have central contracts with the government at all? Why on earth is the secretary of state sending letters to GP surgeries? This sovietized system is so backward, so obviously inadequate, that it’s a wonder it has lasted so long. In such a system the fight is always between producers and governments, with patients hardly entering the equation.

This could all change very simply. Make GP surgeries independent and self-governing. Then have them agree NHS treatment tariffs with their primary care trusts (the local bodies that commission healthcare services). Let them advertise for patients, or group together into chains of GP surgeries to reduce administrative costs. The revenue these surgeries, or chains of surgeries, brought in would depend on how many patients they treated, and on whether those patients were satisfied with the service and became repeat customers.

In such a system you would quickly find that where there was a demand for such services, GP surgeries would stay open later in the evening or at weekends. All their incentives would be aligned towards providing the best possible service. Of course, the left will scream "privatization" and say this amounts to the abolition of the NHS. Yet services would still be free at the point of use and paid for out of taxation.

It's high time British healthcare put patients ahead of political ideology.