We are now facing a new downturn. While everyone's attention has been focused on the Health Bill, a huge problem is quietly developing over the GP workforce.
The financial squeeze on general practice together with the extra work being offloaded on to us means that primary care is no longer seen as a favoured option among newly qualified doctors. As a result vocational training courses are only part-filled; GP vacancies have doubled, applications for GP posts are down by 16% and out-of-hours GP shifts are going unstaffed.
Many GPs in their late fifties, demoralised by recent events, are considering early retirement. Some want to escape the pension upheaval, others to avoid the hassle of revalidation, the irritation of Care Quality Commission registration and the target culture. But the stresses don't end there. GPs are now being asked to give significant amounts of their time to running clinical commissioning groups, even though the remuneration offered often doesn't cover their locum costs - if remuneration is indeed offered at all.
The government also wants GPs to save NHS money by taking on more work from secondary care. Despite our ever-lengthening working days, the proportion of our time available for seeing patients is nose-diving: a quarter of us now have to spend more than 50% of our time on paperwork.
Could the government make general practice less inviting? I doubt it.
The result is obvious: primary care is on the cusp of a workforce crisis. As GPs leave, their work will be dumped on the progressively dwindling number of GPs remaining, in an ever-tightening spiral of overload, exhaustion and resignations.
It is not a pretty picture. What is worse, I'm not sure if anyone in the DH or government has sensed that this current downturn - which at first appears to be just another cyclically receding tide - could actually be the prelude to a tsunami.