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At the heart of general practice since 1960

A prickly Hutton defends Labour's record

I have only been a GP for three years and a partner for a little over one, but I am already absolutely fed up with the shifting goalposts. No sooner have we taken on one major challenge than another appears.

With each of these challenges, another monster undermining our profession rears its ugly head. The two-week wait for referrals has effectively changed us from clinicians and gatekeepers into secretaries; the publication of NICE guidance for everything implies protocols we must follow, and the Government will make them into protocols using quality points, further undermining our ability to treat patients not diseases; Choose and Book will encourage a patient to demand to be seen by a particular consultant at a particular time, whether they need secondary care or not, resulting in another secretarial role; patient records accessible nationwide will reduce the necessity of having a specific GP or GP practice.

I fear that these changes are more to do with taking away our clinical freedom, reducing us to the level of protocol-followers for any given illness and, ultimately, removing the need for GPs at all.

I do not want a system where all patients demand to see specialists immediately, as some of my insured ones do. It makes me feel as if the years I have spent training and practising have been for nothing. Our one hope is that our patients will continue not to read the text books so that we have to do the detective work which is so central to the job.

Dr Alice Hodkinson

Cambridge

·Your campaign has already covered many of the key issues but there are some others around the primary/ secondary care interface that deserve a mention.

·The increasing tendency of hospital consultants to 'work to rule' since their new contract and either refuse urgent, 'fit-in' referrals as they once would, or negotiate extra NHS sessions in local private hospitals to address backlogs.

·The increasing number of hospital clinics partly run by nurse practitioners. While some are excellent, some fail to make decisions, they pass work back to primary care and/or make patients unnecessarily anxious.

·The changes in junior doctors' hours and training mean, increasingly, that they neither understand holistic care nor communicate effectively with GPs, patients and their relatives.

However, we must also appreciate that we tend to get the patients we deserve. Respect is not a divine right of the medical profession.

Having, quite rightly, reduced our commitment to working antisocial hours, we must strive to provide professional, patient-centred (as far as possible) and medically competent care.

Otherwise, many patients will see little benefit in being registered with a single GP, and ultimately we will have contributed to our own downfall.

Dr Ian Schofield

Mountsorrel Leicestershire

·Well done on your campaign. As one GP has already said, we need to be left alone to get on with the job.

Tom Peters, one of the great management gurus of recent times, says: 'Give your people what they need to do the job. Give them the tools, the training and the support they need. Then get the hell out of their way and let them get on with it!' Amen to that.

And for what it's worth, I left full-time general practice in 1998 due to illness and now work part-time doing various GP locums and hospital posts.

I get several offers each year to go back to GP work and I say thanks but no thanks to all of them. A big element of my refusal to go back part-time is that elephant's abortion called the new contract.

Keep up the good work.

Dr Declan Fox

Newtownstewart

Co Tyrone

·Lanarkshire GPs were understandably alarmed when the initial information about the new contract was issued and requested our local negotiator to come and explain the debacle to us.

Dr Mary Church came, but brought a negotiating 'heavyweight' with her in the shape of Dr Simon Fradd.

He did most of the talking, and tried to tell us what a wonderful contract had been arranged for us. Especially he assured us that we would all have a hugely increased pension.

I would like to have him come back and explain why we are now threatened with having to work an extra five years for no obvious increase to achieve a pension at all. Is this yet another example of how our part-time 'negotiators' were hoodwinked by the professional team the Government mustered?

I wait for a satisfactory reply, but will not be holding my breath.

Dr Colin Lees

Airdrie

Lanarkshire

·I think you are doing an excellent job unifying GPs and highlighting their concerns.

In the rush of 'modern is good', the GP elements of continuity of care and offering the highest service to the most vulnerable patients appear to have lost value and many GPs are voicing their disappointment at feeling pressurised into prioritising other areas of practice.

Please add my voice to this.

Dr Jane Wilcock

Swinton

Manchester

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