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The three ages of general practice

The Jobbing Doctor charts the three ages of general practice, stability, uncertainty and now control, and argues the current age is the very worst of all.

The Jobbing Doctor charts the three ages of general practice, stability, uncertainty and now control, and argues the current age is the very worst of all.

The way in which general practice was set up in the UK is unique. Being a self-employed professional who contracts out their services has enabled British general practice to be the very best in the world for many years. There is a freedom in this relationship that has enabled general practice to be innovative, responsive and really cost-effective.

When Jobbing Doctor started his career, this was very much the way in which things worked. They did work pretty well. In my career I would say that that first ten years was an Age of Stability. We gave a good service to our patients; we innovated and taught, we gave 24-hour cover so our patients knew who their doctors were, and there was usually a single point of entry into health services. It was very efficient financially.

There is an age-old adage that says "if it's not broke......don't fix it'. This is a concept that has been ignored for a while and when the GP contract came up for renewal in 1990 there was an appetite in Government for change and increased accountability. This was demonstrated by some disgraceful language from the then Minister (Kenneth Clarke), who accused the profession of ‘feeling for their wallets'.

The new contract was imposed unilaterally, in an act of Government hubris that had the underlying agenda of subverting and controlling general practice. This was the start of an ongoing programme of change and control, with many policies coming and going in a welter of political ‘initiatives'. Over the next 14 years we had the creation of multiple layers of administration, with local Health Authorities, Primary Care Groups, fund-holding and doctors' cooperatives coming and going. The change of governing party seemed to make relatively little difference. All the while there seemed to be an underlying desire to take power centrally. This period of time was very much the Age of Uncertainty for general practice.

It is difficult to look back over the years in your career without a certain nostalgic glow, but even allowing for that, Jobbing Doctor can see that things have only got worse since then. Empowered by an entirely spurious majority in Parliament (that only reflects the support of 26% of the electorate), government then set about dismantling the whole of the current system of general practice: they needed more control and for employees of the NHS to be subservient to the political agenda of the ruling party and their supporters in the media.

This would not be the overt message, which was very much about ‘setting targets' and being ‘responsive to the patients' agenda'; they used causes célèbres (such as the Bristol Paediatric Cardiac Surgery enquiry and the murderous psychopath Harold Shipman) and placemen (space does not allow for a long list of names - they are mostly seen in the honours lists) to push through the current agenda of control and privatisation, disguised in the weasel words ‘choice' and ‘plurality'.

We are now in an Age of Control and slowly the wheels are beginning to come off primary pare: for the first time in my professional career I am being very circumspect about advising people to go into General Practice. Recruitment is very much worse, hours are much longer, administration now takes up an average of at least 2 hours each day, and as a result job satisfaction is reducing all the time.

I get regular comments from GPs at my blog saying that the way that we practice medicine in our partnership is less and less the norm.

Look to London for the reasons.

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