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BMA considers industrial action on pensions

GPs with special interests (GPwSIs) and introduction of multiple care providers may erode continuity of care.

·The RCGP says many GPs believe there is a 'covert agenda to replace GPs' with other health professionals.

·1,400 GPwSIs are already in place with PCTs given carte blanche to recruit as many as they like.

·Labour's election manifesto pledges to abolish registered lists and allow patients to join more than one practice.

·Ministers are pushing ahead with plans for 3,000 community matrons by March 2007 to take over care of chronically ill patients ­ despite sustained criticism of the scheme

GP comments

'GPs provide an excellent, cost-effective service. Meddle at your peril.'

Dr Sue Clugston, Durham Riding, Northumberland

'Stop trying to replace us with cheaper alternatives. If other people want to do what we do at the speed that we do it, let them do the training we have done.'

Dr Alison Davies, St Albans

Defend GPs' clinical freedom

GPs are faced with a mountain of guidelines and increased scrutiny of their clinical and prescribing judgment.

·The NHS National Electronic Library for Health lists 1,200 sets of clinical guidelines in the UK. NICE alone has issued 76 appraisals and 39 sets of guidelines, with 90 more in the pipeline. It believes this will rise exponentially.

·GP standards are set out in nine national service frameworks.

·Some quality indicators tie GP pay to adherence to specified treatments. The clamour for new indicators has already begun, with NICE saying adherence to its guidance could be included in the next draft of the framework.

GP comments

'Stop being prescriptive to GPs and allow us to run the best service for patients.'

Dr Sally Sheppard,

Ivybridge, Devon

'Give us a break. Leave us to get on with the job. I'm fed up with interference.'

Dr Patrick Lau,

Ealing, London

Less tick-box medicine ­ more time for patients

Many GPs feel they are spending far too much time ticking boxes and typing Read codes ­ and too little on the interpersonal aspects of patient care.

·An evaluation of PRICCE, the quality framework prototype, found technical care improved but at the expense of psychosocial aspects of care. The National Primary Care Research and Development Centre says it expects to find the same with the quality framework.

·GPs have ridiculed claims by the Health Secretary that their consultations now average 14 minutes. Even primary care tsar Dr David Colin-Thome has distanced himself from the comments.

GP comments

'Let GPs have more time for consultation and patient care rather than wasting time on paperwork and trying to achieve quality targets.'

Dr Madan Gupta, Oldham

'Put an end to all targets and treat us like the highly-qualified professionals that we are.'

Dr Richard Holman,

Barnstaple, Devon

Trust GPs to do what's best for their patients

GPs increasingly believe ministers are driving a wedge between doctors and patients with their aggressive promotion of the patient choice agenda.

·GPs will have to offer patients the choice of four or five hospitals for referral by the end of the year

·But 79 per cent of patients trust GPs' choice of treatment, according to the NHS Executive's National Survey of NHS Patients.

·The RCGP says there are 300 million consultations with a GP each year, 'almost 90 per cent of the work of the NHS', with a 91 per cent satisfaction rating.

GP comments

'Trust us, the vast majority of GPs do an excellent job, sometimes in difficult circumstances.'

Dr Joanne Herbert,

High Wycombe

'Leave us alone, we know how to do our job...and you don't.'

Dr George Simons,

west London

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