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Can GP values survive in the new commissioning world?

Has general practice lost its values? Some of our authors this week think it has.

Has general practice lost its values? Some of our authors this week think it has.



Professor George Freeman thinks weve never had it so good, and yet he also believes we are losing the values that have made general practice so special and valued by our patients. As often happens, his views are coloured not only by his experience as a GP, but also by the experience of a close family member. Do we always provide the care we would want our own families to receive?

Continuity of care is one of the core traditional values of general practice, but some GPs argue it can no longer be provided, especially as so many GPs work part-time. But Marilyn Long shows how you can organise your practice to provide continuity. So why don't we all do it, if we really believe that continuity of care is important?

Commissioning is going to bring much of this to a head. The Pulse survey suggests there are plenty of conflicts of interest already – 20% of GPs say they regularly feel compelled to follow clinical guidelines that aren't in the patient's best interest. Nearly three quarters think commissioning will increase conflicts of interest. Dr Andrew Spooner is more optimistic. He thinks commissioning is an opportunity to re-establish the values of general practice, but wonders if the new generation of GPs is well enough trained to take advantage.

Commissioning is certainly going to be hard work. There's no doubt we are going to have to look more critically at the resources used by referrals, and many GPs won't welcome that. But they should read Dr Lucy Wictome's piece. She describes the frequent clinical discussions in her practice that have become an essential and valued part of their working lives.

I think general practice is at a critical turning point. Whether we like it or not, we have been handed the NHS budget on a plate. So what are we going to do with it? We have certainly been given a vote of confidence by the new Secretary of State. But does he really understand the enormity of what is being asked? Some have even said we're being set up to fail.

I don't believe that, though I think it will take at least five years before we can judge whether GP commissioning groups have been a success. Despite that, despite all the problems, all the extra work, all the conflicts of interest, this is an opportunity for us to truly change the shape of NHS care.

Commissioning will only be a success if GPs are driven by the core values of patient-centred care. Professor Freeman felt let down by his relative's care. Will you be proud of the care you provide and commission?

Professor Martin Roland is a GP at Nuffield Road Medical Practice in Cambridge and professor of health services research at the University of Cambridge

Professor Martin Roland Click here for more from our guest editor issue Guest editor

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