Patients will lose out on vital services if the government presses ahead with its 48-hour target for GP access, doctors warn.

In the NHS Plan, the government said that by 2004 patients would be able to see their family doctor within 48 hours.

But worried medics say this leaves them ham-strung and puts at risk some of the services they currently offer, such as minor operations, chronic disease management, specialist clinics or health promotion.

And out of 2,203 doctors surveyed, a massive 70% said that if they are required to meet these targets they would probably have to cut the longer appointment times needed by some patients and the number of home visits.

The little old lady who is not so self-assertive may agree to wait a week when she should have been seen straight away

Dr Elizabeth Williams

Consultation times

Eight out of ten doctors quizzed by Doctor Magazine said they felt the access targets were not achievable.

GPs have long complained about the strictures of the proposals, but their leaders say they have so far been unable to discuss them in details with the government.

Dr Hamish Meldrum, of the British Medical Association's (BMA) GP committee, said they wanted longer not shorter consultation times and that this will not be possible under the current plans.

He said more GPs were vital to make any of the improvements viable.

"This survey quite rightly points out that there is a price to pay for increased access.

GPs want consultation times of 13 minutes rather than the current eight

"Until we have a lot more GPs, improved access can only be delivered at the cost of other things that patients value such as choice of practitioner, continuity of care and longer consultation."

The average GP now has just eight minutes to see each patient - they want to see this upped to at least 13 minutes per patient.

Cuts in services

Dr Brian Russell, a GP in Cardigan, Wales, said minor operations were already been cut back because there was not enough time to do them and he said he feared home visits and remote clinics would soon go the same way.

"I don't think the government realises the problems for a rural practice.

"It's the travelling time. We might spend an hour with one patient but that's 40 minutes of travelling time in there."

Dr Elizabeth Williams, of Basingstoke, said she felt that care of the elderly and vulnerable would suffer if the more vocal patients started demanding their rights.

"If all our patients rang up and those who are more selfish demand to be seen in two days then the little old lady who is not so self-assertive may agree to wait a week when she should have been seen straight away."