Competition is the name of the game. As health secretary Andy Burnham points out in an exclusive interview with GP this week, scrapping practice boundaries is not just about improving access - its about driving competition between practices.

Meanwhile, changes in April will allow patients from practices in England not offering extended hours to book evening and weekend appointments at other surgeries.

And if any GP felt more secure after Mr Burnham's claim last year that the NHS was the 'provider of choice', they can think again. This statement was 'misinterpreted'.

One can only assume that if GPs are not up to the job of thriving in a more competitive environment the DoH will have private providers waiting in the wings.

It is not just Labour that expects GPs to hone their business skills. The Tories also want to scrap boundaries and, as shadow health minister Mark Simmonds points out in this week's GP, they expect GPs to take back responsibility for out-of-hours and commission the vast majority of services.

This is against a backdrop of spending cuts, which are likely to mean a GP pay freeze. The DoH's evidence to the Doctors' and Dentists' Review Body called for practices to make 1 per cent efficiency savings to get a pay rise.

At the same time, Mr Burnham expects practices to invest greater sums in improving premises and expanding services to succeed in this new era of competition, balanced scorecards and greater patient choice. MPs expect the same money to go further, which will place GPs under huge pressure.

One has to wonder if some smaller practices will survive, which would leave many patients deeply unhappy. Shiny new premises, extended hours and extra services are not top of everyone's priority list. For many it is continuity of care that matters. But that seems to get short shrift from policymakers in these competitive times.

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