If Scotland's appalling health record is to be tackled effectively, there needs to be a switch of emphasis to individuals taking responsibility for their own health in partnership with their family doctor. At present, many of those who work normal business hours find it difficult to see their GP without taking time off work. This is partly because many doctors stopped offering out-of-hours care when new contracts were introduced in 2005. This new contract was long overdue: the goal of a decent work/life balance for GPs on call at night and over weekends was unobtainable without it. However, it effectively offered doctors more money for less work. This was partly because the new contract tied rewards to results and the government underestimated how much doctors were doing for their patients already.

If Scotland's appalling health record is to be tackled effectively, there needs to be a switch of emphasis to individuals taking responsibility for their own health in partnership with their family doctor. At present, many of those who work normal business hours find it difficult to see their GP without taking time off work. This is partly because many doctors stopped offering out-of-hours care when new contracts were introduced in 2005. This new contract was long overdue: the goal of a decent work/life balance for GPs on call at night and over weekends was unobtainable without it. However, it effectively offered doctors more money for less work. This was partly because the new contract tied rewards to results and the government underestimated how much doctors were doing for their patients already.

It has long been recognised that some corrective surgery is necessary in the interests of patients and taxpayers, who in this case are often one and the same, as many of those requiring an appointment outwith business hours are the very people whose National Insurance and income tax fund the NHS. The current situation involves a cost to the Scottish economy in terms of hours lost and is a factor in the strain being placed on NHS 24 and hospital accident and emergency departments.

GPs are being asked to work an extra three hours a week at a time of their choosing. Talk by some doctors about being bullied or blackmailed by the government suggests they are looking for extra money. Certainly, they should be recompensed for any incidental expenses. But the notion that doctors are being unfairly dragooned into the deal will find scant sympathy from patients. Doctors now earn an average of more than £90,000 a year. Those unwilling to put in an hour or two in the evening or on Saturday morning stand to lose around £6000 from their practice income but would still be considerably better off than they were prior to 2005. Nobody wants to wind the clock back, but if GPs are to play their part in Scotland's health revolution, there has to be a bit of give and take.