The National Service Frameworks, establishment of NICE, the new GMS contract and QOF together with their investment in reducing waiting lists have changed the emphasis and effectiveness of healthcare delivery.
Unfortunately, that is where Labour's success has ground to a halt.
The further development of the internal market, its PFI schemes, its obsession with choice and plurality of providers and the introduction of private providers on favourable contracts has wasted as much national resource as our banking friends in the city.
GPs have always been the most efficient deliverers of care seeing 90 per cent of patients and are the cornerstone and gatekeepers of the NHS.
Patients often present with several problems during a single consultation. Only a generalist could be expected to address all of the patient's problems, without generating multiple referrals to specialist colleagues.
Government should understand that undermining and fragmenting general practice will increase reliance on more expensive secondary services.
A modern, organised general practice, such as mine, allows patients to see GP colleagues who have developed interests in particular areas enabling us to keep referral rates well below local benchmarks, through a referral management scheme.
There is a constant tension between secondary care trusts and primary care, as the trusts try to enhance their income through Payment by Results.
One concern of mine is inappropriate invoicing by secondary care trusts which strips money out of our budgets.
This sort of behaviour does not give me confidence in the ability of an acute trust running GP services. Whichever party is returned after the next election, government should understand that the internal market is an unhealthy option for the NHS as it diverts energy away from efficient delivery of service.
Meanwhile, it must strengthen our hand and influence through the PCT to negotiate meaningful contracts with secondary care providers and divert resources and services where appropriate into the community under the control of NHS primary care organisations.
- Dr Doron Boone, Bristol.