Letters: Four factors to keep GPs at primary care's centre

There is no doubt that this government has behaved pretty badly in its negotiations with GPs. It has also fuelled patient expectations to levels beyond need and means, but our anger and reaction to events risk losing the confidence of our patients.

Much as we enjoyed the pay rise that came in the early days of the new contract, it may have sown the seeds of some of our difficulty now.

Although it was fully justified and negotiated in good faith, it drew the spotlight onto the service we deliver and the government saw its opportunity to go full speed ahead with the deregulation of primary care. Four factors could ensure we remain at the heart of primary care.

Firstly, GPs have traditionally been independent contractors. The combination of a large initial pay rise, a change in the contract terms with the PCTs and the subsequent unravelling of our pay rise has led to a dramatic rise in salaried GPs.

More often than not GP principals are replaced by salaried GPs. While there are genuine reasons for salaried positions I believe this trend has to be reversed quickly. A strong, dynamic and independent-based service is a well-tried and tested vehicle of stability. Those who wish to become principals should generally be able to do so.

Secondly, entrepreneurial attitudes need to prevail. An entrepreneur sees opportunities early and understands the need to engage strongly with their client base. We need to be aiming to up our delivery of quality patient-centred care, thus cementing our position as being highly trusted and accessible.

Thirdly, GPs are already looking closely at forging links with other partnerships and this process should continue. A critical appraisal of three areas - the skill mix within the organisations, the delivery of patient care across the organisations and the ethos of the groups - is the prerequisite for success.

Fourthly, the credit crunch has put the brakes on a raft of private ventures and is likely to consolidate our position in the next few years, if we take a long-term and imaginative view.

It may be a future when income does not increase from year to year but we cannot expect to be protected from the fallout of current economic problems. I believe the future is bright but it will be very different to what has gone before.

  • Dr Stephen Banham, Birmingham.

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