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Disaster or new dawn for GPs?

Dr David Haslam, chair of the RCGP, looks at GPs' future ­ and likes what he sees

Is the glass half full or half empty? Is general practice facing disaster or a renaissance?

While the retrospectoscope is always clear, the crystal ball is always cloudy. But I am one of life's optimists.

Only a very short while ago many of us feared the very existence of our specialty was under threat and any 10-year vision would be of disaster. But I do believe the light has finally dawned with politicians and decision makers.

The evidence is clear ­ a primary care focus improves health outcomes and reduces health inequalities, and so spending on primary care will increase massively.

So what will be the result? While fully recognising that the one thing you can't predict is the future, I will hazard a few guesses ­ and they are optimistic.

nGPs will have much more rapid access to high-quality diagnostic facilities. It won't only be Premiership footballers who can have an immediate post-injury MRI scan.

nBecause of rapid access, referrals will have fallen as GPs will be able to deal with much more in primary care. At present most GPs are all too aware that we sometimes refer much too early in the patient's journey ­ but we don't have the time, the staff and the facilities to do otherwise.

nMore practices will have realised that skill mix is not just a clinical term. High-quality managers and their teams will take care of almost all of the paperwork ­ leaving clinicians to be clinicians.

nMany more young doctors will have opted for a career in general practice following a four-month exposure to quality practice in their second foundation year of training, and with the recognition that becoming a GP with a special interest can combine the best of both worlds ­ personal holistic care and specialised clinical expertise.

nPCTs and GPs will have realised that we need each other ­ that we aren't simply the cause of each other's problems but are the source of each other's solutions.

nWe will no longer go through the madness of printing out computer records when a patient leaves our list, but will transfer records electronically.

nPatients will still say 'While I'm here, doctor', and Mondays will still be busy.

Something had to change

Utopia? Madness? A sign of impending dementia? Not necessarily. In all the concerns that we have about the detail of our new contract it is easy to forget where we are coming from.

For years, our specialty has faced ever-increasing early retirement, low morale, poor investment, second-rate premises and poor recruitment ­ particularly in the areas of most need. Even those who oppose the new GMS contract must surely realise the status quo was not an option. Something had to change.

It has also been all too clear to everyone that this Government doesn't invest extra funds for standing still. Payment based on results has to use measurements, and you can only measure what you can measure.

As the new contract beds in, and is adapted and changed, we need to remember that counting only counts when we know how to assess measurements effectively. Indeed determining better outcome measures will be a major challenge.

The key human skills involved in being a good doctor have not changed in the last 100 years. They must not change in the next 10.

The contract is a way of getting money into our practices. It must not define who we are ­ generalists, professionals and proud of it.

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