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What's in store for 2008?

A years to stand up, be counted and put the patient first - leading GPs cast the eyes forward to the coming year and predict testing times ahead

A years to stand up, be counted and put the patient first - leading GPs cast the eyes forward to the coming year and predict testing times ahead


'If we unite, we can prosper'

The Government is not going to waste energy actually asking those who work in the NHS about their proposals – they are going to go ahead with them anyway. In practice, although Government will talk a lot and threaten much, most patients will still want to see their own doctor and nurse for most of their ailments.

This means that all of us will need to ensure that the service we offer is the best we can make it and that we take every opportunity to control the commissioning agenda before the private sector does.

If you do not want big corporations swallowing your patients or your practice, then get together with other GPs and help the PCO see that you are invaluable to them as a commissioner. Corporate behaviour, co-ordinated by the LMC, will be some protection from predation. Having patients on your side, through earned respect for what you offer, means that you have a ready-primed set of allies.

If we unite to deter Government damage to general practice, to raise standards of care locally and to speak with one voice, then we can promote real general practice and keep our critics on the back foot. This will be the year to stand up and be counted.

'Dark times unless we embrace PBC'

This will be the defining year for general practice.

If it succeeds with practice-based commissioning then it is guaranteed a central role for the future. But if it doesn't embrace PBC – or doesn't succeed in it – then it will be a very dark day.

General practice will end up in a backwater, at the behest of whoever is commissioning or providing primary care.

GPs are going to have to decide what their long-term vision is. Are they going to be community or social enterprise? Which, for my money, allows them to keep faith with their local population and allows them to work closely with other professionals in leading local services. Or will they simply become a limited companies, like any other enterprise?

These are monumental decisions to make this year. If general practice gets it right then I think it becomes by far the most important part of the NHS. If they get it wrong, we become almost an irrelevant part of an NHS which is owned by multicorporates.

'If we sit and sulk, we'll be trampled'

I think what we see at the moment is the growth of a GP underclass – doctors who have decided that they didn't want to be a principal at a time when there were a lot of opportunities in the early 2000s – and now wish they had.

A large number of people coming off training schemes can't get permanent work, or who can't get satisfactory work. There are very few partnerships because there are insecurities amongst partners. I don't think it's that partners are being greedy, I think it's anxiety about whether they can actually afford another partner.

Patients are going to be less likely to see a doctor and less likely to see their own doctor. I think the loss of that personal relationship between patients and doctors actually is something which is very valuable but underappreciated by almost everyone. Once it's gone, a lot of other things fall in its wake.

The main way to survive is that we have to control the system. We have to be the corporate provider, we have to have a GP cooperative, a social enterprise, a company, whatever it is. If we just sit in a corner sulking, we'll be run over in a rush of other people.

'Over-regulation a potential tragedy'

The success of the QOF will encourage NHS managers to introduce more and more targets and guidelines. As practising clinicians we know this won't work - the QOF authors chose their targets carefully and most of the rest of what we do is more complex.

Our challenge as general practitioners is to show that the benefits that good primary care brings to any health care system mostly depend on the clinical freedom to choose the best care for an individual patient.

The improvement in working conditions and increase in remuneration means that gen-eral practice is once again recruiting the cream of UK medical students. It will be tragic if the impact of this increasingly able and motivated workforce on care quality is negated by over-regulation.

Dr Laurence Buckman

GPC chair and a GP in Barnet, north London Dr Laurence Buckman Dr Michael Dixon

Chair of the NHS Alliance and a GP in Devon Dr Michael Dixon Dr Fay Wilson

Secretary of Londonwide LMCs and chair of LMC conference Dr Fay Wilson Professor David Mant

Professor of general practice at the University of Oxford Professor David Mant

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