It's been another hugely turbulent year for general practice, and for many grassroots GPs, a very difficult one. Look at our interactive roundup of the stories which made Pulse's front page over the last twelve months, and GPs seem to have been under attack on every front.

It's impossible to sum up the profession's year in just a few short sentences, of course. But as the Pulse team heads off for the holidays, here are five key lessons from 2011:

1) Pensions are the third rail of medical politics

Few would have dared to predict this time last year that the NHS reforms wouldn't be the single biggest source of GP anger in 2011 – but it wasn't. While the health bill prompted politically-charged debate, it was ministers messing with GP pensions which became the defining story of the year. When Pulse first revealed the Government was to raise the GP retirement age to 65 back in January, 1,700 GPs signed the petition we took to Downing Street, but industrial action seemed an unlikely prospect. Now, with BMA members to vote in January on a package which includes retirement at 68, increased contributions and a tougher deal for NHS high-earners, it no longer seems inconceivable.

2) Practices will have to learn to live with the pay squeeze

Practice budgets are looking tighter than ever, with an effective pay cut of 4% announced in March and a further 2% drop on the horizon for 2012). But this, perhaps, was the year when pay freezes lost their capacity to surprise, and anger was rather muted – instead, practices are grimly preparing to make staff redundant.

3) CCGs are the new PCTs

Forget the ongoing debate over size or structure – what's really significant about clinical commissioning groups is that they are already proving just as tough at clamping down on practices as PCTs ever were. Whether it's cracking down on exception reporting, implementing 'special measures' or limiting GPs to as few as four new referrals a week.

4) The BMA doesn't rabble-rouse easily

We mischeviously awarded the BMA the 'Che Guevara Award for Revolutionary Activity' in our end-of-year review, and with good reason – in a year when GPs had a lot to be angry about, the BMA sometimes struggled to express that anger. RCGP chair Dr Clare Gerada's willingness to provide outspoken opposition to the health bill it was she rather than the BMA who became the de facto spokesperson for the profession on the NHS reforms. Instead the BMA spent a large part of 2011 fighting with itself, at its first Special Representative Meeting for 19 years, and then in a series of heated BMA Council debates. On pensions, too, the BMA has come in for criticism – although its promise to ballot on industrial action if members reject the Government's deal points to steelier resolve for 2012.

5) No easy answers on the biggest question of them all

The issue which dominated Pulse's letters pages and comments forum above all else in 2011 was, well, the existence of God. Or at least, whether GPs who believe in the existence of God should be able to offer to pray with patients, after Kent GP Dr Richard Scott was hauled up in front of the GMC. As we head into Christmas GPs are probably no clearer on where exactly the lines are drawn – but what is clear is that sometimes the most fundamental issues affecting GPs' day-to-day practice are decided a very long way away from Whitehall.

There are many more key lessons no doubt, and we'd like to hear what you think we've missed in the comments below, or by email.

You can also read our end-of-year awards for a light-hearted take on some of the key stories, including the Unlikely Punk of the Year, the Malcolm Tucker Award for Most Vigorous Denial and the Unwanted Christmas Present of the Year .

The Pulse offices will be shut over Christmas and New Year, and Pulse newsletters will return on Tuesday 3 January. Which means that all that remains for me to do is to wish you, on behalf of the whole Pulse team, a very merry Christmas and a happy New Year.