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More of your views on 2008

GPs look forward, if that's the right way of putting it, to the coming year. With national battles raging on access, pay and IT and local fights on almost anything, there's little optimism.

GPs look forward, if that's the right way of putting it, to the coming year. With national battles raging on access, pay and IT and local fights on almost anything, there's little optimism.

‘Access will be a big challenge for me next year. The government will put pressure on PCTs and PCTs will have no option but to put pressure on me. My patients are happy, but the challenge will be other people's perceptions and how I am going to handle that pressure. As a single handed GP, I am not sure how I am going to offer eight til eight access.

I also am concerned about the number of patients finding themselves in hospital. Emergency admissions are going up, A&E attendances are going up. It is an exciting challenge and an opportunity for next year. This is a challenge for practice-based commissioning. As a practice based commissioner, I have a vested interest in keeping admissions down as I can be spending that money next year.' Dr Lis Rodgers, a GP in Doncaster and clinical lead for unplanned care at Doncaster West



'I'm looking forward to the prevention of the further erosion of holistic care, which is the by-product of the increasing fragmentation within some aspects of Government health policy. The over-reliance on different, or new, providers within primary care at the expense of developing existing capacity is a barrier. We saw that with the change in provision of out-of-hours services, that people were being shunted from pillar to post. We need to get back to individual patient care.' Dr Rubin Minhas, Gillingham, Kent

‘It's the NHS. Expect to be treated poorly, expect to lose income, expect longer hours – and wake up and do something about it. I do believe GPs should review the intellectual need for a universal minor non-patient threatening action to avoid a five to ten year slide.

I fear GPs will fail to appreciate that the unquestioned loyalty of our patients that has been our major weapon is being deliberately undermined by a centrally-led propaganda campaign. If we do not address it now, when we have our usual ‘sort out the cash or we resign' crisis, we will actually find a government and a populous saying "Fine, do it and come back working for this private sector agency as an employee on £55 an hour".

The single biggest issue facing GPs will be the forced implementation of Lord Darzi's review. This is one gift horse we should look in the mouth.' Dr Andrew Mimnagh, chair of Sefton LMC

‘I see nothing but gloom for doctors. Professional standards of patient care will be sacrificed to providing the dumbed-down service that the NHS can afford. The reason the NHS can only afford second rate treatment is because of the huge waste on walk-in centres PFI, management consultants, NHS IT and huge wasteful management costs.

Doctors will be gagged from comment with the threat of reporting them to the government controlled GMC. Computer programmes will replace doctors and patient satisfaction will plummet. Costs will go up and care disappear. The NHS is doomed unless doctors make a stand - and I believe that they won't.' Dr Tony Le Vann, a GP in Doncaster



One of the major things in 2008 of course will be the changes to the QOF, which cynics will say is going to more work for the same money. QOF has been very good for patient care, but more changes and more demands might make it feel like we're always being asked to do more.

This next year, there will be a lot of pressure on general practice. Eventually, we will get to breaking point and we won't be able to keep up with it any more. I enjoy being a GP and GPs are very adaptable professionals but I fear we will reach a point where they will shift the goal posts too far and we won't be able to take it any more.' Dr Kathryn Griffith, a GP in York


'I want to see a more constructive relationship between General Practice, the Government and the Department of Health. The non-stop carping about ‘overpaid GPs' etc is really exhausting professionals' patience. GPs have had a sizeable in-crease in pay for a sizeable increase in efficiency and work, from a position in which the specialty was struggling to recruit top candidates against hospital competition.

Yet how the Department of Health have managed to combine that with an increasingly antagonistic and distrustful relationship is baffling, and surely wouldn't happen in any other profession. I would really like to see in the new year that being addressed by someone in the DoH. It's not outrageous to suggest that the campaign has been orchestrated from there and certainly they have not been proactive in stopping it.' Dr Martin Hadley-Brown, Thetford, Norfolk.


‘I would like to see a change where government and managers are on the same side as GPs. I run a PMS practice. PMS in some ways was a good idea to start with as it gave you a choice about how to run things. But the way things are going, they can renegotiate the contract – just tear it up and say you are not doing it anymore – and in some areas chop a third of your budget off. You can't run a business like that.

I feel sorry for the youngsters coming up. I am looking forward to retirement.' Dr Tom Frewin, a GP in Bristol and member of Avon LMC

‘I am concerned by the trend towards less partners and more salaried doctors will con-tinue creating a generation of resentful, disaffected GPs with poor contracts who feel as though they are second class citizens. I fear that the opportunity to radically change things for the better, presented by the Darzi review, will be squandered and that we will all continue working in our "silos" in primary care/education/secondary care or social care.'



‘GPs face one of the biggest upheavals in their history after health minister, Lord Ara Darzi unveiled plans for a radical new primary care model; polyclinics.

It is an unnecessary structural change which will divert re-sources away from current premises, inhibit the modernisation of GP surgeries and will result in thousands of GPs being rounded up into central locations reducing access to those that most need it.

The rosy vision of GPs and specialists working under the same roof bears no likeness to reality. The Government's focus on purchaser provider split and payment by results has driven a wedge between us and its proposals make no mention as to how this will be over-come.

I challenge any Government to find a model anywhere in the world that can match our range, remit and responsibility. We may be the best paid GPs in Europe, but just look at what we provide compared to the rest.' Dr Kailash Chand, a GP in Ashton-under-Lyne, Greater Manchester and BMA council member

‘But I am hopeful that the Government's planned walk-in centres and health centres will be commissioned well and contribute towards improving access to primary care in the places that it is most needed.' Dr Dennis Cox, a GP in St Ives and chair of Lord Darzi's Staying Healthy group for the East of England

‘Whatever the Government says about listening to patients, it doesn't. Suffolk PCT has decided to impose a 15% cut in our practice budget and a total cut of £320,000 in the primary care budget for Haverhill. Unfortunately it seems that nothing can be done.

We have given the PCT statistics which show that the consulting rates for all three GP practices in Haverhill are above the national average. We've got 300,000 patients who much prefer to be in a small practise with no waiting list than a large one where the doctor is different every time.

The PCT's own figures show that Haverhill patients have higher than expected atten-dances at A&E both in and out of hours. Despite this, they choose to stick to the Carr-Hill formula which tells them that Haverhill patients warrant only 85% of the national average funding. I don't see any positive opportunities in the forthcoming months.' Dr Ross Worthington, a GP in Haverhill, Suffolk

'Revalidation must be very carefully introduced, in order to keep GPs on side and make any assessments realistic in terms of time and cost. Similarly, there should be improvements to IT and Choose and Book. It either has to made to work smoothly or scrapped altogether.

‘There is a challenge in future months relating to the ongoing deficits in some PCTs. Here in Cambridge we are seen as an affluent area so less deserving of health spending, but this weighting ignores the fact that the population has just as many health needs as other areas. In terms of opportunities perhaps Lord Darzi's report will help focus on how the NHS can improve, and guide the Government's decisions.' Dr Fiona Cornish, a GP in Cambridge and treasurer of the Medical Women's federation

‘The new BTS SIGN guidelines for asthma will be published next spring and there will be some challenges in that for primary care. There will be some changes in the management of asthma and tightening up of the diagnosis of asthma up a little bit. GPs and nurses are going to have to respond to that in the way that they make a diagnosis, perhaps thinking about being more scientific.

We don't really know yet what is going to be in QOF next year. There were a few things that we recommended, including removing annual spirometry checks and categorising COPD patients' disease into mild, moderate and severe to target therapy. But I would like to see if they actually come out next year.‘ Dr Iain Small, a GP in Peterhead and incoming chair of the General Practice Airways Group

Dr Rubin Minhas Dr Kailash Chand Dr Kathryn Griffith

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