NAPC warns: 'You don't know what you've got 'til it's gone'

General practice is under attack.The future no longer seems as certain and inspiring as it once did. We should turn our attention to the state of primary care in some of our inner cities, while simultaneously casting our eyes across the pond.

The quality of primary care in the UK is generally very high, and the envy of many countries in the developed world.

But the quality of primary care available to some of the vulnerable of our cities' populations is woeful in places.

The profession has failed to manage this challenge itself and, because of the current cost of primary care, which in most places is merited, the government has chosen this period to tackle the problem.

These Darzi-type solutions are not welcome in many parts of the country. There is still just time for professionals to come together to address the needs of failed populations and deliver integrated care.

What is happening in health maintenance organisations (HMOs) in the US is also having a considerable influence here on government. Nurses interact with patients routinely and technology is used more rigorously and imaginatively in the management of patients with long-term conditions.

Self-care is also high on the agenda. Doctors do what only doctors can do. This is what we are seeing being proposed in polyclinics. GPs should reflect on their practices' organisation and ensure that their skills are maximised and deployed effectively and efficiently.

Studies consistently show a strong a relationship between more and better primary care and improved access to health services, improved health outcomes and lower overall costs.

Evidence points to a strong general practice at the centre of an integrated primary care system as the only strategy able to contain rising healthcare cost, reduce pressure on secondary and tertiary sectors and meet the needs of elderly people.

There is a danger, if the government pursues its current agenda, which is laden with anti-GP messages, that, as in the words of the Joni Mitchell song: 'You don't know what you've got 'til it's gone'. We shall regret the passing of our general practice.

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