Just consider the nightmare scenario...

January. Following the Southall case, any doctor criticising a parent in court is automatically reported to the GMC if the parent is then found to be not guilty.

In February this is extended to all criticism anywhere, so telling a patient they are late or obese becomes a striking-off offence.

March. The pilot study performing terminations in primary care is extended to the whole country. Individual GPs can opt out on ethical grounds, but any that do forfeit all development and enhanced services money - 3,471 GPs resign in protest.

April. All appointments with GPs are compulsorily handled through Choose and Book. By May the Choose and Book system has filled every available GP appointment for the next three weeks. Large numbers of patients attend A&E as the only way to be seen urgently. The government penalises all practices for not hitting their access targets - 5,371 GPs take early retirement.

June. With the primary care workforce in decline the government issues regulations forcing GPs to remain in practice until age 75 - 353 deliberately have affairs with patients in order to get struck off and hence retire. Three die in the attempt.

July. Following the death of a patient from MRSA after suture removal, all GPs are required to have FRCS before performing minor surgery.

September. Primary care collapses. The DoH blames selfish, overpaid GPs for failing to stick by their patients. It introduces knowledge testing, striking off all GPs who don't score 98 per cent or more.

October. There are now just 1,765 GPs in the entire country, all practising from super-surgeries (they have to - each has 34,000 patients). The DoH requires all GPs to attend 20 hours of management meetings a week.

November. The only GPs left working are those in full-time management roles.

December. The health secretary announces a new role: 'New Labour General Practitioner' - a vocationally trained doctor whose job is to see primary care patients and act as a gatekeeper for the NHS. They will take on all primary care medical roles and do minimal paperwork. 'This will undoubtedly bring complete efficiency to the NHS,' he says. 'It's the right thing to do.' For once - just once - he is absolutely right.

Chris Lancelot, a GP from Lancashire. Email him at GPcolumnists@haymarket.com

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