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At the heart of general practice since 1960

Urban areas find recruiting GPs harder

Yet another group of non health specialists has had a go at shaping the future of our health service

The right wing Adam Smith Institute has considered whether our healthcare system meets today's healthcare needs.

It has decided that in many ways it doesn't and has given us a snapshot of what effective healthcare might be like in 10 years' time.

Come 2015, GPs will still be independent (for them to be anything else would cost too much, and the political Right loves the idea of competition).

But our PCTs will have been dissolved and their purchasing responsibilities taken over by local commissioners. This would see us operate in a form of managed care ­ the American HMO model. We would have contracts between our hospital trusts, private providers and anyone else wanting a look in.

Quality and efficiency

GPs would still be commissioned as practices. We always seem to end up doing the same thing because what we do is already efficient and high quality. You might come up against a super surgery or two trying to gobble up your patients, but patients are a loyal bunch, they'll probably want to stay with you, so not much to worry about there.

Private corporations and supermarkets will be in on the act (Boots and Tesco have already started in a few areas). But again, don't worry. When the going gets tough patients always head back to their GP waiting room.

The big trusts might also aim to get a toe hold. Guy's & St Thomas' is currently trying a GP outreach scheme.

Additional sources of revenue

Then there is the matter of core services. We will have core contracts with our commissioners for routine services. Patients will then be expected to pay for top-ups, such as travel, family planning and other non-core enhanced services. This would include home visiting!

We'll also cram in physiotherapists, occupational therapists, counsellors, psychologists and just about anyone else who can generate revenue into our surgeries.

Payment will be by private insurance, managed employer healthcare schemes and some form of state bail out for the less well off.

Funding will still come from taxation but additional sources of revenue will improve healthcare. Choice and quality of provision will be better.

So our lives could be pretty cushy. Good levels of reimbursement and additional revenues with some real and timely referral packages; demand more realistic as patients start to appreciate and pay for healthcare costs; and NICE bites the dust as well.

Sounds like cloud cuckoo land to me.

Dr Andy Jones is a GP in Stamford, Lincolnshire

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