Pension action, hospital closures and Andrew Lansley's future on the line... 16 senior GPs give their predictions of the likely – and not so likely – for the year ahead.
BMA chair and formerly a GP in Bridlington, east Yorkshire
‘It's depressing, but it's difficult to predict much good news for general practice this year, as we start 2012 surrounded by so much uncertainty. The chaos being caused by the Health and Social Care Bill in England is likely to continue and with it the growing sense of disillusionment among GPs, ironically the very group the Government wanted and needed to get on side. But, as pragmatists, I suspect most GPs will do the best they can for their patients.'
Wild card: ‘Ending the fixation on top-down, structural reorganisations – including dropping this one – would be on my wish list, as would a coherent plan for the huge financial challenges facing the NHS.'
Chair of the NHS Future Forum, former RCGP chair and a GP in Birmingham
‘We need to focus on delivery of high-quality primary care in 2012 – it's great GPs are now seen to be the key players in the NHS, but we need to ensure we provide the highest-quality care possible. We will need to reduce unacceptable variation and work smarter with our primary care teams – moving towards longer consultations while our colleagues take on more of the "rules-based" care.'
Wild card: ‘The ultimate goal is a more integrated health and social care system. We can make this work through provision locally and our key role in commissioning in England.'
Dr George Kassianos
RCGP lead for immunisation and a GP in Bracknell
‘2012 will be a year when a large number of NHS hospitals will collapse under two strains – financial and capacity. Hospitals will go deeper into financial difficulties with only two solutions: closure – and some will close – or being taken over by the private sector. The private sector will then demand a change in the payment system and before we know it, the NHS will be a different health system, one that is provided by private hospitals and foundation hospitals.'
Professor Helen Lester
Lead on QOF development programme and a GP in Birmingham
‘The QOF currently has about 40% of its points allocated to different types of outcome or intermediate outcome indicators. I'm sure, in line with Department of Health policy, there will be an even greater number of outcome-focused indicators going into the pilots in 2012.'
Wild card: ‘With the proviso that overall practice income isn't affected, I'd love to see less money attached to the QOF, bringing us more in line with other "pay for performance" systems internationally.'
Dr Simon Fradd
Chair of Concordia Health and a GP in Southwark, south London
‘This year will be a wake-up call for PCTs and CCGs. In 2011/12 most PCTs and commissioning groups probably will just about manage to balance their books, to meet the 4% efficiency savings by making savings or fudging it. In 2012/13 they will find they can't go on doing that. People are going to have to learn to think outside the box.'
Wild card: ‘A great deal of telehealth needs to come forward. I suspect this won't be the year, but it has to come to the fore much more quickly than people were anticipating.'
Professor Mike Kirby
Professor of health and human sciences at the University of Hertfordshire and a GP in Radlett
‘There will be increasing activity around atrial fibrillation because of the need to prevent strokes and increasing interest around new anti-thrombotic agents. We will see more centres offering immediate angioplasty for patients with chest pain. There will be a lot of activity in practices getting up to speed around ambulatory blood pressure monitoring, and more proteinuria testing for patients with early CKD.'
Wild card: ‘More interest in new agents for treating diabetes, particularly GLP1 agonists.'
GPC deputy chair and a GP in Leeds
‘The financial pressures on the NHS will increasingly dominate. We've seen PCTs and CCGs try to pick low-hanging fruit for their efficiency savings over the last couple of years. They are no longer there. For CCGs to be able to maintain financial balance, they will face very difficult decisions that will place GPs in leadership roles in very difficult positions against the will of their colleagues and patients – and make them deeply unpopular.'
Dr Kailash Chand
Chair of NHS Tameside and Glossop and former BMA Council member
‘I predict a year full of crisis – with the NHS reform bill coming on there will be a lot of tension and pressure in primary care. If the reforms go through, PCTs are being destroyed and CCGs are at a formative stage. It will be a hard and difficult time for general practice.'
Wild card: ‘There's a remote chance the bill may not go through and Mr Lansley's political future will be on the line.'
Dr Peter Swinyard
Chair of the Family Doctor Association and a GP in Swindon
‘The BMA is going to go to war with the Government over pensions. One way they can do that, which is consistent with BMA Council policy, is to advise GPs not to engage with commissioning. If the BMA asks GPs not to engage, then the whole of the health reforms will go phut!'
Wild card: ‘Some of the better GPs may walk away from commissioning and say there's better things to do with my time. That would be a sad thing.'
Dr Dean Marshall
GPC Scotland chair and a GP in Dalkeith
‘The Scottish Government's stated policy of no front-line cuts will be exposed and general practice will start to see cutbacks, such as the removal of support by district nurses, a further break-up of the primary healthcare team and attempts to remove funding from general practice by health boards in order to make savings.'
Dr Rory McCrea
Chair of Chilvers McCrea Healthcare and a GP in Waltham Abbey
‘There's going to be a bigger move towards home and community healthcare as hospitals become smaller. Provider arms will have to step up to the mark or there will be new entrants around ambulatory and medical home care. Provider arms are not necessarily set up to do the more medical stuff, and some of the other companies are more pharmacy-led, so there's a gap in the market for developing doctor-led home care.'
Wild card: ‘CCGs will be a stronger force for change than the NHS Commissioning Board.'
Dr Vicky Weeks
Chair of the GPC Sessional GP subcommittee and a GP in Southall, west London
‘As PCTs go and CCGs come in, hopefully we will finally see information cascaded to all GPs. Sometimes information only goes to one GP at a practice or the practice manager. Locums are not hearing about things like new prescribing protocols, clinical governance or what's happening in their local CCG. But 40% of the workforce is now sessional. The penny has got to drop.'
Dr Amir Hannan
Primary Care IT lead, NHS North West, and a GP in Hyde, Greater Manchester
‘With the right level of support, there will be many more practices offering online transactional services for patients including booking appointments, ordering prescriptions, viewing test results and some offering full access to the GP record. There will be greater clinical engagement in IT developments. The ‘Renal Patient View' online tool will be deployed in most renal units with more than 60% of renal patients attending hospital able to access their renal records online.'
Professor Kamlesh Khunti
GP and professor of primary care diabetes at the University of Leicester
‘The main thing this year is the NICE guidelines on early protection and prevention of diabetes in February or March. It will encourage CCGs to think about protecting people at high risk of diabetes and reducing that risk.'
Dr Andrew Dearden
BMA treasurer, member of the BMA pensions committee and a GP in Cardiff
‘The Government will see a large number of older GPs resigning or coming out of the NHS pension scheme, drawing their pensions early and reducing the number of hours they work for the NHS. We are already starting to see vastly increased numbers of enquiries and once the Government imposes this new pension I expect we'll see a doubling or even tripling of the annual rate of retirements.'
Wild card: ‘My outside bet, although I'd say it's more likely than an outside bet, is that for the first time in living memory the BMA will ballot its members for industrial action. It is the first time in almost all doctors' careers that we've felt sufficiently angry to even consider being balloted.'
RCGP chair and a GP in Lambeth, south London
'In 2012, the RCGP's 60th anniversary year, we will rightly see patients and patient care take centre stage. The move we've already seen begin towards doctor-patient partnerships will continue, with patients taking a greater role in their own care. Above all we need to empower and enable patients, and keep them at the heart of everything we do.'
Wild card: ‘That instead of focusing on yet more organisational change, we are able to focus on what matters – a doctor who is kind, who cares and who knows what to do. Or that we get our extended training. Or that David Nicholson realises how important GPs are to the NHS and orders 10,000 more to provide care to patients.'
