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Plan for new quality targets for PMS GPs

Dr Hamish Meldrum

Reduced majority may lead them to slow pace of reform

GPC chair Dr Hamish Meldrum believes the new Government may be 'less radical' in its third term as it

tries to cope with a reduced majority.

'The traditional wing of the party may put the brake on some of the reforms,' he says.

'The Brown camp will also have perhaps a little more say in the direction of travel.'

Dr Meldrum said he would try to convince the new Government to 'use the contract as a framework to promote general practice'.

He added: 'I think it's worthwhile investing in general practice and I want to make sure they understand that.

'We've got to try to work with them. We've managed to have a fairly good relationship with John Hutton.

'There's got to be a sensible change of pace otherwise we'll be overwhelmed.'

Dr Meldrum expected spending to be maintained for another two years but that 'pressures' would emerge towards the next election once spending on the health service was reined in.

Professor Alan Maynard

They'll plough ahead with

the increased choice policy

Professor Alan Maynard reckons that a third Labour term will see a continued focus on increasing choice in the NHS.

'Adherence to the choice policy seems inevitable,' he says.

'Some shift to nurses may alter workload and private competition may reinforce the trend to deliver much of primary care via nurses.

'However, this is largely an evidence-free policy that requires careful evaluation ­ nurses may be as good as GPs in many roles but this should be proven and costs estimated to identify cost-effectiveness instead of them merely asserting it is efficient.

'We have to consider whether we have reached "flat of the curve medicine" in some areas.'

Professor Maynard, professor of health economics at the University of York, added that the reshuffle of ministers at the Department of Health may harm the NHS. 'With the departure of John Hutton there is no ministerial memory of the policy formation process in the hectic recent past.'

Dr Mike Dixon

Ministers have learned that GPs are very unhappy

Dr Mike Dixon, chair of the NHS Alliance, thinks the Government has now learned the lesson that 'GPs are pretty grumpy'.

He says: 'Instead of finding policy thrust upon us we'll find it's discussed with us in advance.

'I think they will stick with the policy as it is but the style will change so that frontline GPs will feel more involved and less imposed on.

'The lessons they have learned are that GPs are pretty grumpy and that 10 Downing Street will want closer contact with the frontline.

'The whole issue of access is interesting. Instead of barracking about it, we should be producing the solution ourselves.

'One thing that's in no doubt is that primary care will be top of the list for the next six months as a result of the problems with access.

'They will look to loosen some of the ties to let practice-based commissioning go forward.'

Dr Mayur Lakhani

GPs are now being heard but we must stay united

Dr Mayur Lakhani, chair of the RCGP, believes the Prime Minister when he promises to listen to GPs and other NHS staff on public services.

'I think we're being heard,' he says.

'The next five years will be crucial ­ probably the most crucial in terms of the future of general practice.

'I'd urge all GPs to be united. If GPs are not united we will get a marketplace in primary care.

'PCTs have not been successful at commissioning ­ GPs want those levers to improve patient care.

'I urge GPs to be open-minded and bold. There's a track record of change and innovation and the opportunities for GPs to be innovative are probably the greatest they have ever been.

'The college will be actively pushing our manifesto. I would say it's a more positive agenda we're working with. I hope they are in a listening mode.'

Dr James Kingsland

Hoping for a major NHS redesign in a year's time

Dr James Kingsland, chair of the National Association of Primary Care, wants the Government to continue to push through its NHS reforms and not slow the pace of change.

'I'm hopeful that the agenda of adding to devolution, choice and plurality of provision, will continue.

'There's massive scope for improving inefficiencies in the system. I wouldn't be supporting practice-based commissioning if I didn't think we could be more efficient.

'If it's going to work primary care is going to have to extend patient management. We'll have to have more specialist nurses coming out of hospital and we've got to prove to them that the NHS is good to stay in.

'There's going to be a pace of change that practices will have to work to.

'Maybe there will be a major service redesign in 12 months' time. By the third year if we still have 180 PCTs it won't have worked.'

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