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CAMHS won't see you now

Why I join patients in thanking all you GPs

Prime Minister Tony Blair picked Pulse when he wrote for us in 2002 on the launch of the new contract framework ­ here he returns to his chosen GP paper to map out the future for general practice

April sees the start of the new GMS contract ­ arguably the biggest opportunity to improve primary care in a generation. By 2005, funding for primary care will rise from £6 billion to £8 billion a year, linked to clinical quality. Of course there will be teething issues, but by giving you more control over your working lives, including out-of-hours, it offers the chance to signal a renaissance in general practice.

Of course some commentators argue that increasing specialisation means the very notion of general practice is under threat. In my opinion that misunderstands the nature and importance of general practice. GPs are 'specialist generalists' whose role in integrating and co-ordinating care is likely to become more, not less, important as the population ages with the associated increase in chronic conditions.

That is not to deny that for many patients with one-off problems speedy access to treatment will be important. 'Advanced access' techniques plus new services such as walk-in centres show that primary care can meet these legitimate expectations. At a time when taxpayers are funding NHS improvement it is right that the NHS responds to the people's priorities.

An improvement in responsiveness to patient requirements has been matched by marked improvements in quality. Premature deaths from cancer are down 10 per cent over the last six years. Premature deaths from cardiovascular disease are down by 23 per cent. But we now also need to ensure the NHS is fit to help the 18 million of our fellow citizens with long-term conditions such as diabetes, asthma, depression and heart failure.

Primary care is central to this challenge. People with chronic diseases account for the majority of GP consultations, and the World Health Organisation estimates that by 2030 the incidence of chronic disease in the over-65s will have doubled.

PCOs will have a crucial role to play. In my view, stronger PCOs do not have to mean merged or bigger PCOs ­ much of PCOs' strength derives from the quality of their relationships with the practices and the professionals that comprise them.

Yet relying on a reactive consultation-driven system will be increasingly insufficient. As John Reid pointed out last week, around 3 per cent of the at-risk elderly account for around 35 per cent of the unplanned hospital admissions for that group. Many of these patients were not in contact with any community health or social care services. Many of the emergency admissions were for conditions that are entirely preventable with an early intervention.

That is why improved chronic disease management ­ with empowered patients plus 'case management' of high-risk patients ­ has great potential to improve quality of care, while

improving patients' experience and making better use of PCO budgets.

Building on the NHS historic strength of registered practice populations, it will require the new electronic health records and IT systems, new incentives, but above all greater recognition of the role that GPs, nurses and other members of the primary care team can each play ­ when properly resourced and supported.

The new GMS and PMS contracts provide that opportunity, backed by genuine extra investment. That is why they are so important. And why I join patients across the country in thanking you for your continuing skill, compassion and commitment.

Tony Blair

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