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How my 2009 predictions fared – and five more for 2010

By Steve Nowottny

It seems a long time ago now, but back in January 2009, I kicked off this blog with a spot of foolhardy crystal-ball gazing. Twelve months on, and it's time to tally up how my forecast fared.

Look back at the five predictions in my original post, and it's clear they were a mixed bag.

  • Full steam ahead for tighter regulation: Well yes, the threat of tighter regulation and audits, whether through balanced scorecards or CQC inspections, was a key theme throughout 2009 – although the general attitude towards revalidation among GPs still seems to be that they'll believe it when they see it.
  • But polyclinics pause for breath: 2009 was indeed a period of adjustment, and financial considerations if nothing else seem to have stopped all talk of a further deployment of GP-led health centres. In fact, as they opened across the country and began to actually see patients, the Darzi centres found themselves under increasing scrutiny – our investigation in July revealed how some were receiving up to seven times the funding level of GMS practices.
  • Private sector to keep circling: Perhaps a bit premature on this one. A bold plan from Sainsbury's to launch 200 GP franchises apart, private sector posturing was remarkable in its absence. But expect fresh interest in 2010, particularly if the Conservatives take over in Whitehall.
  • Financial confusion: This there undoubtedly was. As predicted contractual changes did indeed ‘throw up some unlikely winners and losers', notably with the scrapping of the square root formula and the reworked patient survey. But what I failed to predict – and what became in some ways the defining health story by the end of the year – was the widespread financial gloom currently enveloping all parts of the NHS. There are tough times ahead.
  • Make or break of the Summary Care Record. This more than ever remains the case. In November the Department of Health announced that it was dispensing with trials of the rollout at selected GP practices in favour of a mass rollout for more than 10 million patients – with the Tories decidedly not keen on a centralised care record, the future of the project hangs in the balance ahead of a general election.

And what of the coming year? In no particular order, here's five more predictions for 2010.

  • The NHS becomes a key electoral battleground: a safe bet this, given that hostilities have already begun, with sniping over the health service heralding the unofficial start of the election earlier this week. But with clear blue water finally opening up between Labour and Conservatives' health policies, the future of the NHS is likely to be the subject of intense debate over the next few months.
  • All change at the top: it's never over until it's over, of course, but the smart money is definitely on a Conservative victory in the general election. And if that happens, expect some fundamental changes throughout the health service. Increased use of the independent sector, a greater emphasis on public health and scrapping the NHS IT programme as we know it will be top of the agenda.
  • Renegotiation of the GP contract: again, dependant on the election result, but the Conservatives' plans to hand much greater commissioning responsibility to GPs will involve a fundamental rewrite of the core contract. Shadow health secretary Andrew Lansley's claims in October that his party had reached ‘consensus' with GP leaders over proposals which would see practices take on responsibility for real budgets received short shrift from the GPC – expect negotiations, if they happen, to be protracted.
  • Patient power takes off: it's been talked about for donkeys' years, but thanks to the internet, 2010 could be the year GPs really feel the impact of patient power. Forget balanced scorecards – PCT bean-counting criticism can be easily dismissed. But a cogent, reasoned complaint from one of your patients, who you saw this morning and has published it to the world on NHS Choices this afternoon, is a whole different ball game. Whether or not the Conservatives would get rid of NHS Choices in its current form, the patient power genie is out of the bottle.
  • A return for continuity of care: OK, so it's a long shot, this one, but why not end on an optimistic note? Continuity of care has been under relentless assault from all sides in recent years, but there are signs that maybe, just maybe, 2010 could be the year it comes back in fashion. Professor Martin Roland, leading GP academic and architect of the patient survey, publicly criticised the Government in July for focusing excessively on access at the expense of continuity of care. A heavyweight King's Fund inquiry into quality in general practice is due to report towards the end of this year – could it provide the impetus for renewed investment, contractual or othehrwise, in continuity of care?

It's all guesswork, of course. But while some news events no one can predict (swine flu pandemic, anyone?), a bit of horizon-scanning's always worthwhile. For our first issue of the year, to be published next week, we'll be asking opinion formers from across general practice what they expect to see from 2010. They, no doubt, will have some more fully-formed ideas of what to expect.

And we want to hear from you too. What do you hope – or fear – the year will bring? Let us know in the comments.

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