Chris Lancelot on... Planning for general practice

Where is general practice going? I really wish I knew.

The government is clearly not content with the NHS in its present form and is frantically trying to change things around. Each idea seems to have developed in isolation, either as a whim of the prime minister or else in response to single-issue focus groups. As a result new initiatives rain down on us without necessarily being desired by the patients or approved by the profession.

Extended opening may look good on paper but will reduce the number of daytime appointments, and the majority of patients don't want it. Super-surgeries offer economies of scale - except that patients have repeatedly expressed a preference for small practices. It may make economic sense to devolve hospital work on to primary care, but if this is done without proper resourcing of buildings, skills and people then it won't work. Closing casualty departments and district hospitals may look reasonable to the DoH, but is hated by the electorate and considered dangerous by the majority of professionals working in non-metropolitan areas.

Now add into this heady mix the frankly incompatible demands on GPs in the future. The White Paper 'Our Health, Our Care, Our Say' wants specialist care moved into the community to free up consultants' time; yet the NHS Employers' deputy director Sian Thomas reportedly said there was no future for GPSIs and that care in the community should be carried out by hospital specialists. So should GPs of the future train to be GPSIs or generalists? Who knows?

This is a recipe for disaster. How can anyone plan the future of the NHS under contradictory conditions? The government needs to get a grip. It must apply rigorous logic and produce a strategy for the NHS (and by implication, for primary care) that is realistic, researched, properly resourced and above all, integrated - as without this, we cannot plan beyond the next two years, never mind the next 10.

No wonder forward planning for general practice is so difficult. The government's approach is scatterbrained. It has no idea what it wants - but is determined to get it.

Dr Lancelot is a GP from Lancashire. Email him at

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