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Being a GP is who we are, not just what we do

Dr Fay Wilson takes the reins this week as guest editor of Pulse, helping shape the news agenda and select features. Here she offers her take on this week's top stories

Dr Fay Wilson takes the reins this week as guest editor of Pulse, helping shape the news agenda and select features. Here she offers her take on this week's top stories

In general practice some things never change, whereas others are transforming out of all recognition. Take the role of women in the profession.

The number of female GPs has vastly increased in the past decade, associated with sharp rises in the proportion of part-time or portfolio doctors. This has changed expectations among both male and female GPs, who now demand a better work-life balance.

Whether the increase in women has altered the fundamental nature of the profession is a more difficult question to answer, and is a point discussed in our Views section this week.

But although the number of women entering general practice has increased impressively, the number breaking through the glass ceiling and out onto the roof is - as with other professions - disappointing. As guest editor of Pulse, I was keen to find out how many women were now making it into senior roles in leading bodies.

The answer is not enough.

But while there may be stagnation here, elsewhere in general practice dramatic changes are afoot. With the Darzi reforms, the likelihood of a tougher QOF driven by NICE and the scrapping of the MPIG, next year is set to be one of far-reaching shifts.

Questions

There are real questions over where all these changes leave the work of a GP. The idea in some quarters that routine care, and particularly chronic disease management, can and should move to nurses and pharmacists is gathering pace.

In this issue, we reveal that in Darzi's GP-led health centres, there will be three nurses to every GP. Polyclinics emphasise convenience over continuity, with appointment slots for non-registered patients and commissioners paying only lip service to ongoing relationships.

This reinforces suspicions there is a policy to do away with the long-term doctor-patient relationship.

Could it be GPs are to relinquish their role in the long-term care of patients, and instead become providers of episodes of medical care, like some sort of primary care A&E or outpatient department? Will referral management systems take over gatekeeping and will nurses become the patient advocate, usurping the traditional GP role and our relationships with individual patients?

Are such relationships now outdated?

There are parallel questions about who will run general practice. There's an increasing sense that to have a real leadership role, a GP will have to be the holder of an APMS contract, working in a large organisation.

APMS is a world from which many GPs are disenfranchised:a world of entrepreneurs and business managers, where being a doctor is just part of what a GP does. But for most GPs, being a doctor isn't what they do - it's who they are.

That's a distinction that politicians rarely understand.

Dr Fay Wilson is a GP in Birmingham and a member of the GPC. She was until last week a medical director of Londonwide LMCs and she chaired the last LMCs conference

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