The future is brighter for GPs

RCGP chairman Professor Mayur Lakhani explains the college's vision for the future of general practice to Colin Cooper.

Why is there a need for this 'road map'?
There is a lot of uncertainty in general practice. Registrars are asking questions like: 'Will general practice exist in 10 years? Will I have a job?' We started this project to come up with a vision for the future.

Some people say that the profession does not have a vision, but it does. This is also a practical document - something that GPs can use to improve their local NHS and challenge crazy ideas like patients registering with A&E departments instead of practices.

What will happen to GPs?
The role of GPs will be even stronger. We will command the confidence of patients. But I do not believe that current models of care will deliver what patients need. And that will affect all of our futures because we all need a good GP.

How does your vision differ from current policies?
This is the comeback of personal doctoring. People do not want to be treated like numbers. The registered list is the key.

The idea of patients registering with A&E shows that policymakers do not understand the value of personal care.

This model is an alternative vision to polyclinics that focus purely on diseases and technical care. Co-location of services is important, but not polyclinics.

Why do practices need to work together?
If practices link up they can cope with demands and make things happen. The practice should remain the unit of care - local and accessible - but they need to work together. The federated model is essential to challenge market-led reforms. GPs need to think of themselves as part of a movement, a force for good.

How should practices start to collaborate?
I would urge every local GP community to come together and discuss this report and decide how to work together as soon as possible. They can do informal co-operation, or form a legal entity, or they can go to the City and get money to do something big. There is no specified size or model. We want an organic approach. This document is a framework, not a directive from London. It requires strong leadership from local GPs.

Do practices have the managerial skills to make this happen?
The organisation of care is key. We need to take a more strategic approach and become a force to be reckoned with. We need more practice managers with MBAs.

What about education and training?
We want practices to become learning centres, training all professionals in primary care, including consultants. Why do you need to learn to be a doctor in a hospital, when 90 per cent of the care takes place in the community?

What will policymakers think of your vision?

I want the government and PCTs to be positive about general practice and believe in it, but also know that we are not complacent.

We want to be a progressive, dynamic profession, and the way to do that is through autonomy and leadership.

When is it all going to happen?
This process needs to start now. We want to see organised practice groupings very soon, providing highly organised patient care, taking care of communities, with that vital professionalism and commitment to patients.

We are still seeing signs of vocation in young doctors who might not be interested in owning premises but still have a passion for clinical work.

So the future is bright for GPs?

The future is bright for general practice but we must embrace new and modern ideas.

I believe that professionalism is the way forward. The future is in the hands of GPs. I am confident they will rise to the challenge and this document gives them the support to do it.

The RCGP's vision
Our vision is for a stronger and more vibrant general-practice-based primary healthcare system that is patient centred, which provides consistently high-quality, safe, needs-based care.

This can be achieved by expanded - but integrated - primary health teams offering a wider range of services in the community with expanded access to diagnostics.

We suggest that virtually all health problems in the population - including mental health - could be dealt with in the community with short-term referral as needed.In a complex healthcare environment, the future GP will be offering patients advanced relationship-based primary medical care.

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