Much of Londonwide LMCs' work in recent years has involved helping practices deal with heavy-handed performance management by PCTs.
But far from welcoming their proposed abolition from 2013, Dr Tony Stanton, who steps down as joint chief executive of Londonwide LMCs this month, is concerned that when GPs are in charge of services, they could be 'even worse' performance managers.
'We know how to help when NHS managers have exceeded their brief, or put undue pressure on practices. But I am more worried about the relationship between practices in a consortium,' he says.
'For instance, whether the more enthusiastic take over and struggling practices are even more aggressively treated.'
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How GPs will be perceived by patients and the media once they control huge swathes of the NHS budget is also a major concern for Dr Stanton.
He believes a media backlash against GPs is 'inevitable' - and warns that for some 'it could be a very uncomfortable experience'.
But a glimmer of hope for GPs comes from the high esteem in which their patients hold them, he adds. 'GPs have a high level of trust. It may be that over time, with proper education, people accept these decisions.'
Meanwhile, foundation trusts and large teaching hospitals present as much of a threat to general practice as the much-maligned commercial sector, Dr Stanton believes.
'I see them as a real threat to primary care. Because of the way they are funded, it would suit them to directly manage or have a huge power over primary care.'
Endless reorganisations
Dr Stanton has seen 'endless' reorganisations of the NHS in his long career - especially in London - but says the latest reforms have the potential to be the most radical.
After 27 years in general practice, working as a GP in the navy and a partner in Northamptonshire, how has general practice changed?
Undoubtedly for the better, says Dr Stanton. The stereotypical GPs 'closing at lunchtime to play golf' he came across in the 1970s have completely gone, he says.
'Most GPs now are working very hard from dawn to dusk. The work is more intense and GPs have been rewarded generously, which I agree with,' he says.
The nature of Londonwide LMCs' work has also changed over time, says Dr Stanton.
Reforms to the NHS complaints system, which he helped to shape, mean LMCs no longer spend as much time dealing with them.
Tension between partners
'Now the thing we see more and more of is tension between partners. And there is a lot of work helping practices being judged in some way by their PCT, for example contract reviews.'
Many small and single-handed practices in the capital face continued pressure from PCTs. 'But there has not been some kind of cull,' he says.
'The truth is it is very difficult to deliver what patients expect now and what the PCT think it is paying for. There are extra pressures over and above normal surgery like extended access. If you are a sole practitioner in less than adequate premises it becomes difficult,' he says.
To keep the peace between GPs and maintain unity in the profession, Dr Stanton would like to see reform to the way sessional GPs progress into partnerships. He says the rapid rise in the number of sessional GPs in recent years is causing division and tension.
'Virtually every GP used to be a principal, so there has been a major interruption,' he says.
'Young GPs aren't ready for being a partner from day one. If they can progress to that status over a period of time it may appeal to the profession. Otherwise, what is the difference between practices and large commercial organisations just hiring doctors?'
PMS contracts
A GPC negotiator in 1987, and member of BMA council from 1988 to 1992, Dr Stanton believes the invention of PMS contracts caused 'a genuine problem' for the GPC, because it 'lost its monopoly negotiating rights'. But he is hopeful that the recent NHS White Paper's proposals for a single GP contract may reverse that.
Despite his concerns about the White Paper, Dr Stanton defends the BMA response to date. 'The BMA has to represent all branches of the profession - so you would expect a more cautious response than the GPC,' he says.
What will London look like when GPs control commissioning? Dr Stanton believes GPs will progress broadly in the same direction as former health minister Lord Ara Darzi suggested in his Healthcare for London plans - moving care out of hospital into the community. The proposals were recently halted by health secretary Andrew Lansley.
As NHS reforms take shape, it will be key for GPs to stick together. GPs running consortia must make sure their colleagues don't end up dreaming of the days of PCTs.
