How 2010 will shape up – by GP leaders

By Pulse news desk

The leading lights of the profession give their predictions on what will dominate general practice over the next 12 months

Professor Steve Field, RCGP chair

The financial situation will be the key to everything that happens this year regardless of which party gets in to power.

There will be pressure on general practice from a number of different angles, one of them will be on cost containment. I suspect there will be pressure about income and increasing what people might define as productivity. Productivity whilst maintaining quality will be the big themes.

The election in a way is a sideshow compared with trying to promote the absolute key role of the GP and primary care as the solution rather than as the problem. My hope for this year will be that we can continue to keep the profession united, and to improve further the quality in general practice whilst being able to defend what we're doing.

We've got to focus on what works, have zero tolerance of poor quality and be flexible enough to change when needed. So, for example, I think we should really push much harder for longer consultations, and more integrated healthcare teams.

In order to deliver all that, we need to be more assertive than we've been in the past about the need to have better training for nurses based in primary care, better training for GPs, longer training for GPs, and better support for CPD.

I'm incredibly optimistic that general practice can really stand up and be counted at this time when the health service is entering a period of potential crisis from constrained funds but increased costs. I think this will be one of the defining years in general practice, and whichever party gets in, they will need us to be taking the lead in commissioning, and in provision of care, because hospitals are frankly far too expensive and care needs to be pushed out into primary care.

If we don't stand up and be counted then specialists will increasingly take on the work we are doing.

Dr Laurence Buckman, GPC chair

Two things will be big. One is the election, and what that means for the health service.

I suspect it doesn't mean very much, because there isn't a big difference between the political parties. But it will mean the normal business of Government is suspended for months. So, it's a very dangerous time for the health service because politicians will promise things.

Don't ever listen to a politician promise something and think it won't happen when they get into power, because it will.

The other big issue is the financial situation. If the health service comes out of 2010 unscathed financially I will be very relieved. I wouldn't bank on it, but that's a big hope.

For the health service itself, I think we will see a lot of retrenchment. Not for political or ideological reasons, but for straightforward economic ones. In other words, I think a lot of the initiatives that GPs have found particularly irritating are going to fall by the wayside.

In one sense GPs will be pleased, but they will be disheartened by another load of change in the health service. I think the watchword for this year is going to be quality.

We have to show we are better than alternative kinds of primary care provision. We have to mindful of what service you are offering, look at it critically, and say, ‘how could I do it better, how can I see off rivals from outside general practice'. People have to consider how their practice looks to the outside world, and to do their best to make it as attractive as possible.

Dr Clare Gerada, RCGP vice-chair

The biggest challenge is going to concern the workforce. We have reached the perfect storm – we now have extended our hours, most practices are offering extended hours, we have urgent care centres manned by GPs and Darzi centres open from eight until eight. It's already becoming very difficult to fill these hours and it's going to be even more difficult.

The retirement bulge that has been predicted for some years has not happened but in my practice we find it incredibly difficult to recruit doctors. The increasing complexity of general practice means we require more people to do the same job.

In London, for every GP that retires, we need two or three to replace them.

More doctors are choosing to work part time, the profession is becoming increasing feminised, and there's a big change in the profession and the big challenge over the next two or three years will be to address this whilst also offering new GPs meaningful career progression.

We have swung the pendulum too far in favour of extended hours and we need to think about that impact that has on the continuity of care. We need to have a serious debate about whether the Government's policies can be married to the ability to have a workforce within a family-friendly profession. Sitting in a practice at 7am on Christmas morning is not family-friendly.

If I were in a position of power I would ask for an examination of these policies, and I would ask how far we can and should deliver them.

I am very optimistic about the calibre of young GPs coming through and we need to make sure it is an attractive and appealing profession for them.

Dr Michelle Drage, joint chief executive of Londonwide LMCs

I hope that the NHS will be returned to the public sector and will not continue to be fragmented by the private sector. I also hope that the management budgets will be shrunk and not primary care funding.

I hope that we promote the uniqueness of what we do, but I fear that we have been so beaten up that we won't be able to stand up for ourselves any more.

I hope we will stop talking about primary care when we mean general practice. General practice is being eroded by being conflated by other things. Over time more and more things have muscled in on what we do. Primary care workers – by and large – work for NHS organisations and by stealth general practice has become subsumed into that arena.

It's really important that we market our unique selling point to the public – what we do for them over a long period of time. The challenge is to demystify what we do for the general public. The time has come to make it really clear that the only people who can deliver what you get from a GP is a GP. By getting that message out perhaps we can turn the corner of getting the blame for everything.

Realistic possibilities are quite thin on the ground. I think that this is going to be a tough year. At least, for the period of six week and six months after the election we will find a bit of peace and respite from the constant and useless change.

Dr Michael Dixon, NHS Alliance chair

My New Year's wish is threefold. That the Government will trust and work with GPs rather than tell them. Collaboration instead of confrontation.

That the Department of Health and managers all the way down the system will enable and encourage GPs to lead improvements in service and health – encourage not thwart their talents for innovation, commissioning and extending provision outside hospital.

Finally, that general practice itself will up its game. That it will re-state its commitment to personal care and continuity, while extending its role to improving local health and services with a clear message that patients come before profit.

In short, my wish for the NHS in 2010 is a serious outbreak of trust and altruism. If the market won't save the NHS, commitment and hope can.

Dr Paul Charlson, chair of the Conservative Medical Society

A new Conservative Government is absolutely crucial. It will be a disaster if we don't get one, or if we get a hung parliament.

Healthcare hasn't seen the recession yet, it will be an exceptionally tough year for people working in the NHS. We need to address the huge bureaucracy and cut it back sensibly.

If we get a Conservative Government, we will start to work on reducing this, but it's going to an exceptionally tough few years. However, I predict we will see the rise of PBC under a Conservative Government, with clinicians getting back some of their enthusiasm.

Professor Helen Lester, QOF adviser and professor of primary care at the National Primary Care Research and Development Centre

I believe with all my heart that primary care provides excellent care to the vast majority of people. Of course there are occasional errors in primary care but there does seem to me to be an increasing culture of ‘primary care knocking' which can be dispiriting and demoralising to those working long hours at the pointy end of primary care.

So what do I hope for 2010? I hope there will be less focus on needless structural reorganisations and a far greater focus on developing and consolidating cross sector partnerships, which can then lead to better patient journeys between health, social care and welfare sectors.

With my QOF hat on, I will continue to speak truth to any power that plans to pay primary care on hard outcomes (e.g. smoking quit rates and mortality) instead of process and intermediate outcomes measures, since this may well lead to a series of unintended consequences including greater GP reluctance to work in deprived areas and an exacerbation of the inverse care law.

2010 will also be the year when the credit crunch really hits the NHS. If National Health Service spending rises at 1% for the next 3 years, and demography alone suggests the need for an annual real term increase of 1.1% a year as the population ages, this would mean real cuts in spending of over 12%. With a greater focus on improved productivity for the same money, all NHS staff will also need to run faster to simply stand still. Do we have the capacity to do this? I hope so but fear we may struggle.