General practice feels pretty close to the bursting point. Recruitment firms are already seeing a surge in demand for GPs, as practices desperately try to plug the gaps left as partners are sucked into commissioning meetings.
Each practice is facing the nightmare prospect of designing nine separate care pathways under the latest QOF changes, with no new resources with which to do it.
So it is impossible to imagine a worse time for GPs to be confronted with a new wave of bureaucracy, in the form of the Care Quality Commission's compulsory practice registration scheme.
The CQC, mindful of its own workload, decided not to try to roll out registration across health and social care all at once.
On this occasion, general practice has been spared the role of guinea pig, with that honour going to dentists instead. It's fair to say they have not enjoyed the experience.
The British Dental Association says preparing for last week's registration deadline has been ‘shambolic' and caused its members ‘severe stress'.
Some dental practices have been setting aside half a day a week for six months as they attempt to meet a host of registration standards across 21 separate categories, on everything from infection control, to criminal record checks, to their managerial structure.
It probably doesn't help that they have had to pay for the privilege, even if the CQC has reduced dentists' fees from £1,500 to £800, presumably to avoid mutiny.
Just like revalidation, it's difficult to remember exactly what CQC registration is for. If 300-page guidance documents and more than 90 hours' preparation are the answer, then what was the question, and why did it scare the Department of Health so witless?
It's not that GPs will be opposed to the principle of having their practices and premises given the once over. Given the risks when medical care goes wrong, it is possible to make a case for almost any system of scrutiny, if taken in isolation and applied proportionately.
CQC registration, though, does not exist in isolation – but in a world of appraisal and revalidation, balanced scorecards,
QOF assessments and NHS Choices ratings, with more on the way when the new health and wellbeing boards start showing their teeth.
And there will be nothing proportionate about the new system, if the BDA's stark warning is anything to judge by.
One function of CQC registration is to give practices, and private firms the quality stamps they need to be any willing providers under the new world of GP commissioning. But any consolation GPs may feel at the thought that at least the CQC will help keep private firms in check will surely be dispelled when the inequities dawn upon them.
A private company, perhaps running GP practices and Darzi centres right across the country, will surely be far better equipped to cope with the bureaucracy of registration than a GP practice, just as large practices will cope better than small ones.
The CQC must surely implement a system that takes into account these disparities in resources. Otherwise, in the process of measuring everything about general practice, it will damage much of what makes it so valuable.
CQC registration and many other practice challenges will be on the agenda at this year's NAPC conference: pulse-seminars.comEditorial