What's up, Doc?

If you're a doctor in England - I mean a medical doctor, a GP - here's the good news: you've got a great salary. (And don't forget that's all due to the last Labour government which really just wrote the BMA a blank cheque to keep the doctors onside.) Reports have it the average salary for a GP is now £103,000.

But the bad news is, the present Conservative-Lib Dem government isn't convinced they are getting what they're entitled to from you in terms of workload and hours in return for all that lovely dosh. Never mind the exams you've sat, the training you've had, the hours you've worked in hospitals, the fact that you are now working in and maybe even running a surgery with lots of other doctors and ancillary staff, juggling childcare to meet the demands of your shifts there, not to mention the house calls and the paperwork you take home in the evenings and at weekends because that's the only time you can do it. Jeremy Hunt has been on the telly, all twinkly-eyed and smiling, and laying down the rules for healthcare.

Welcome to the 24/7 society. Your patients work the longest hours in the EU and are employed in non-unionised workplaces, where the company makes it clear it doesn't like them to be sick or to take time off for a doctor's appointment. If your patients are away from the workplace, their wages are cut or they get so much hassle from the boss they're more or less forced to work when they're not fit. In the end, some of them just neglect their health, which sometimes means the NHS has to pick up the debris at a later stage when their ill-health costs more to fix - if it can be fixed.

But nothing, nothing, can stand in the way of capitalism. We are all working to serve the needs of upper management and the shareholder.

So you doctors need to get with the programme (have you guessed yet which part of the world these attitudes have been imported from?) and start working evenings and weekends. You need to be at the service of the patient. We're not prepared to pay for a proper out of hours medical service and A&E is groaning under the burden of ingrowing toenails and bad backs, so it's over to the surgeries to take on the extra burden. And don't bother mentioning that the population is growing , especially the older population who need more care than the rest.There's no money. It's all to be done within existing resources.

And after we've made the surgeries into havens of 24/7 care, we'll move on to the hospitals: we'll have operations going on round the clock, get the consultants working non-stop, have even more unsocial shift-working for nursing staff.

The trouble is, of course, that the bean-counters - and I include Jeremy Hunt in their number - haven't got a clue how surgeries and hospitals work. I've been in hospital a few times. I dozed off on my bed one night in Neuro at the Southern General and woke at 11pm to find the consultant standing there reading my chart. Another consultant appeared at my house after I'd been discharged because he wanted to keep an eye on how I was doing. I also know of nursing staff who are due to start work in day surgery units at 7am who turn up at 6.15 because they know that's the only way to do all the prep work that patients need before their ops.

Making the NHS into a 24/7 service will not stop NHS staff doing their job but it will stop them taking the extra step for patients. It's insidious: you feel you've been badly treated so why should you give more than the service is prepared to pay for?

It happened with teachers in the 1990s: suddenly when teachers' working hours were dictated to the minute by employers, they stopped giving their own time - unpaid - to extra duties so  no schools' football, no after-school clubs, no school trips. The education service was poorer for it. Some things, like after school homework clubs, started up again later but the teachers had to be paid to do them - with funding diverted from other areas, of course.

Sadly, I've no solution to this problem, except maybe a change of government. And maybe I should emphasise that this is happening in England - or is it England and Wales or England, Wales and Northern Ireland. Not in Scotland. We have our own set of problems but I hope we don't go down this road.