Editorial: What a difference one year can make

This is GP's last issue of the year which means the team has been thinking about the past 12 months and what we might expect from the next.

About a year ago we were expecting a fair amount of change. There were concerns over the future of the national GMS contract, DoH advisers were talking about pre- and post-operative checks being provided in GP surgeries and the first rumblings about extended opening hours were beginning to surface. Oh, such innocent, halcyon days.

Now the differences in GMS between the four UK countries seem swamped by the other innovations to primary care contracts emerging mainly from England. There is Heart of Birmingham PCT's 'franchising' plan which seems set on tearing up the existing model for delivering care in the area and starting again - although without the involvement of multinational companies, it now says.

In contrast there is the Darzi plan for 150 new surgeries which are likely to operate on alternative provider medical services (APMS) contracts and are very likely to involve private providers and larger companies. And this is before one considers the renegotiation of PMS contracts - the very model that was intended to reform primary care just a few years ago.

A few pre-op checks seem small beer compared to the current plans to move large chunks of hospital care into polyclinics - despite there being no agreement on who will provide care in this setting.

The extended opening debate has grown and grown despite there being no real evidence to suggest it would improve health outcomes. And to round off the year we hear that practices may have to be licensed by the successor to the Healthcare Commission, regardless of revalidation and relicensing plans for doctors.

Unfortunately what has not emerged over the year is a clearly agreed blueprint of what primary care should look like. Yes, we have had the RCGP road map but that is not agreed by all the players. What primary care needs is debate and most importantly an agreed and detailed plan emerging from that debate on the shape of general practice, its funding and its staffing, that will be left in place for long enough for real outcomes to be measured.

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