It is no surprise that GPs do not think much of the government. Nonetheless, a few eyebrows were raised by the scale of the disaffection revealed by GP's survey (GP, 7 January).
Just 15 per cent of the profession intend to vote Labour at the next election - barely a third of the number who backed the party in 1997 - and more than half rate the party's NHS record as poor. If the profession had its way, David Cameron would be in Number 10 right now.
So where has Labour gone wrong?
The survey was not all bad news for the government. Nearly two thirds of GPs think primary care has improved on Labour's watch. There was praise for the fall in waiting times, the focus on preventive medicine and, yes, the increase in funding that went with the 2004 GMS contract.
The biggest rave reviews, however, were reserved for the quality framework. Seventy-one per cent of the profession reckon it has had a positive impact.
'The new contract, for all its shortcomings, has focused our efforts toward more relevant groups of patients,' wrote one GP in the survey, adding: 'Pity there is so much drivel attached.'
Accompanying such rare praise came complaints featuring a familiar cast of villains: bureaucracy, polyclinics, and the commercialisation of healthcare.
But perhaps the most common cause of dissatisfaction is something more nebulous than that: a sense that GPs have neither the respect nor the autonomy they once did.
Some expressed frustration about the endless string of new government initiatives, and attempts to control general practice using targets. 'We are better at ticking boxes,' one GP notes. 'But I'm not sure if this equates to better service to patients.'
But others were less quick to blame the government for any decline. 'The concept of the family doctor has been destroyed.
'Doctors no longer know their patients or their families,' wrote one. 'We signed away our moral standing by giving up out-of-hours care,' wrote another.
Calls for change
So much for the diagnosis. But what could a kindly minister do to treat these various ills? GP also asked its readers to identify the single most important thing the government could do to improve general practice.
One of the more optimistic responses suggests allowing GPs to retire on full pension at the age of 55. But on the whole, despite falling profits and Daily Mail stereotypes, financial issues barely feature.
Common suggestions include abandoning the commissioner/provider split, bringing back fundholding, and educating patients more about their own health. A surprisingly popular option was to introduce a nominal charge to see a GP - 'to cut down on nuisance', wrote one.
Another common complaint came from salaried GPs who feel they have had a raw deal from partners who employ them. One was angry enough to call for the government to 'stop GP partners using the NHS as their private business and exploiting everyone else caught up in it'.
Suggested fixes included financial incentives to take on partners, rewriting the GMS contract, or putting the entire profession on a salary.
Other popular suggestions included full NHS independence, so that GPs could just get on with it, or simply showing them more respect: 'to allow GPs to feel they are valued,' wrote one.
The overwhelming sense one gets while reading the survey results is one of exhaustion - with change, with interference, and with a government that has lasted nearly 12 years.
This exhaustion could explain why many respondents felt unable to give credit to the government for improvements to the NHS since 1997.
'The quality of care has improved,' wrote one GP, 'but so have preventive medicines and primary care structures. I don't think it's in the least due to political leadership.'
What GPs want ...
- The government should set up an independent panel selected from medical, nursing and managerial experts. Then leave the NHS alone and fix the trains.
Fairer terms for salaried doctors:
- An end to the two-tier system for GP pay that pits partners against salaried doctors. The GMS contract needs changing to stop this.
- They should think before recommending changes - it might be best to not have any for a while. That would be a change.