Money: Will the doctor see you now?

When most people feel ill their first step is to consult their general practitioner. Getting past the receptionist is hard enough, and then you may have to wait several days for a non-urgent appointment. But over the next few years it is going to get even harder to see the doctor as the Government has announced plans to make nurses the first point of contact for many less serious problems.

If that concerns you, or you are too busy to wait to see your doctor, then there are going to be plenty of enterprising private GP schemes waiting to take your money.

The Government's plans, announced last week, will create 20 experimental walk-in centres open daily from 7am to 10pm and staffed by nurses. The Prime Minister claims this will help people who have to wait too long to see their GP and bring the NHS up to the pace of modern life.

Some pounds 30m will fund the centres this year, with a further pounds 280m over the next three years. The money will also pay for an extension of the nurse-led telephone health helpline, NHS Direct.

The British Medical Association is not impressed. Dr Judy Gilley, joint deputy chairman of the BMA's General Practitioners' Committee, says the advantage of general practitioners is that they hold your medical records and are responsible for your care 24 hours a day. "How will these walk- in centres fit in with that - how will continuity of care be ensured?"

Even if they are a threat to general practice, at least these centres will be free. Many of the other new schemes will hit your pocket. What you will be buying are the added flexibility and convenience that busy patients feel their NHS doctors can no longer offer.

Medicentre runs 12 private walk-in surgeries across the UK, the first of which opened at Victoria Station in London in 1996. Other centres are based at shopping centres and supermarkets with opening hours ranging from 7am to 10pm, says Medicentre's Jennifer Holloway.

Each centre offers a complete set of GP services, as well as health screening, physiotherapy, weight control clinics, stress counselling and aromatherapy. Travel vaccinations, cholesterol tests and Viagra prescriptions are also popular.

Consultations last 15 minutes and cost pounds 36 and you don't have to make an appointment to see a doctor. NHS prescriptions cannot be issued so patients have to pay for a private prescription.

A Medicentre survey found that 27 per cent of people would be willing to pay to see a private GP. Centres in London see 1,000 patients a week. Typical customers include passing commuters, people who have difficulty getting time off work and the self-employed.

Norwich Union Healthcare has launched GP First, a primary care health insurance. GP First, which claims to be the first of its kind, provides 24-hour cover and health screening services.

The scheme offers treatment through Medicentres and costs pounds 120 a year for adults and pounds 54 for children. This covers four free consultations annually, some minor surgery (such as removal of stitches), health screening and use of a 24-hour GP helpline.

If you live within 20 miles of a Medicentre you can have a private GP home visit at any time of the day or night for pounds 45. Norwich Union is also piloting corporate private GP services, and one day your employer may offer you this as part of a perks package.

Norwich Union is not the only private medical insurer expanding from hospital to general practice-based policies. PPP healthcare is piloting its Personal GP Service in two NHS practices in Dorset and Portsmouth, with a further 10 pilots planned.

Average monthly premium will be pounds 25, although this will vary according to age, sex and state of health, and there will be no limit on the number of consultations.

The option of private GP care is also available on an individual basis through NHS practices across the country. Ask your GP if you are interested.

The medical care is pretty much the same as on the NHS. What you might expect to get are appointments of 20 minutes compared with the NHS average of seven minutes, extended opening hours and a more personal service.

Go private and you will still have access to NHS hospital care though, again, you must pay for any prescriptions. The PPP healthcare pilot scheme puts an upper limit on the amount you pay per treatment; after that it is covered by the insurance.

Another forthcoming doctor-led private practice scheme, the Network for Private General Practice, aims to recruit 3,000 doctors to a franchised family doctor service. Brian Goss, a doctor in Suffolk, has already recruited 300 doctors and hopes to launch the service by the end of the year. It should operate a telephone service directing patients to doctors in their local area and a centralised medical records system.

Dr Goss denies the scheme will undermine the NHS by creaming off patients who will then be less willing to support health services through taxation.

"We are not eroding the NHS. Anything that takes people out of the NHS, which has a fixed budget, will ease pressure on its finances," he says.

Contacts: Medicentres, 0870 600 0870; GP First, 0800 0562591.