Soon after becoming health secretary last year, Andy Burnham was hailed as a man planning to steer the NHS away from private providers when he announced: 'The NHS is our preferred provider.'
Not everyone was impressed, however. GPC chairman Dr Laurence Buckman has since accused the health secretary and the Labour party of wanting to 'destroy general practice'.
With election campaign chaos unfurling around him, Mr Burnham resists an early offer to trash Conservative health policy when we meet at the DoH's headquarters on Whitehall.
He admits 'we're in that mode now', but prefers to talk up Labour's achievements over the past decade. Primary care is 'unrecognisable from where it was in the mid-90s', he says.
Misinterpreted on 'preferred provider'
Despite the praise his 'preferred provider' statement initially attracted from unions and patient groups, Mr Burnham now explains that it was perhaps misinterpreted.
'People shouldn't apply undue significance to that statement,' he says. 'It means existing employers have a chance to rise to that challenge before we open it up to other providers. It does not change the policy this government has pursued.
'I'm not going to flinch away (from the private sector). When we are building new services, let's bring in the full range of ideas and new thinking, and make it a competitive process.'
As for Dr Buckman's belief that Labour wants to destroy general practice, the health secretary's initial response is that he 'can't possibly imagine why Laurence would say that'.
The GPC leader's claim came in response to From Good to Great, a five-year road map for the NHS published last year.
But after reflection, the health secretary admits: 'If he's talking about a version of general practice where we're not doing as much work, and we're single-handed GPs, and that version of general practice becoming a minority, he's probably right.'
This attitude towards small practices and workload might have contributed to Labour's nosedive in popularity among GPs (GP, 15 January).
Confronted with a GP poll showing GPs prefer Conservative health policy to Labour's, Mr Burnham says there are 'paradoxes and inconsistencies'. He points to a GP poll last year, which found that 63 per cent of GPs think primary care has improved over the past decade.
'Morale clearly is low and people have a legitimate right to disagree and say when we get it wrong. But at the same time a healthy majority of GPs say that services have improved significantly and I take great comfort in that.'
Driving competition between practices
So where will Mr Burnham take the profession next? He returns to the idea of scrapping practice boundaries often, and increasingly talks about it driving competition between practices, rather than simply letting commuters see a GP near work.
'Let patients vote with their feet. Then perhaps GPs have to think about investing, and services, in a different way. If they're not keeping up to date with facilities people expect these days, with opening hours, they can expect to lose patients,' he says.
With the burden of registration and revalidation looming, and PCT scrutiny growing, Mr Burnham promises 'vigilance' to stop bureaucracy eating into GPs' time with patients, and to listen to the GPC.
When it comes to practice-based commissioning (PBC), there is a profound lack of fresh ideas. Mr Burnham talks vaguely about putting more 'oomph' behind it; but the policy has already been 'revived' and 'reinvigorated' repeatedly.
He instead warns that Conservative plans to force commissioning responsibility on GPs will 'fundamentally alter GPs' job' and increase bureaucracy. 'Let's not wipe away the important role of commissioning at PCT level,' he adds.
Big challenge on long-term conditions
The health secretary sees the treatment of long-term conditions in the home as GPs' big challenge in the coming years.
'The relationship between GPs and secondary clinicians will get closer, and we will see more integration of services.'
Changes to tariffs this year will encourage hospitals to work with primary care and keep people out of hospital, he says.
He is also focused on giving GPs quicker access to tests that traditionally have been carried out in hospitals. Patients with suspected cancer will eventually be told by their GP: 'We can do it here and now in the practice and have your results today,' says Mr Burnham.
The health secretary rates UK primary care and the GP contract among the best in the world. But he wants to push on with reforms, and admits 'creative tension' is inevitable.
But he adds: 'We don't just sit around and think of new ways to wind up GPs. We really don't. We shouldn't let those differences cloud what has been a positive achievement for the government and the profession.'
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