Your Practice 2010: The future of UK general practice - Dr JamesKingsland launches our debate on the future of the profession

We have now completed almost six years of the government's 10-year plan for the NHS. Since January this year, the government's White Paper has been directing the reorganisation by promoting expansion in community-based services at the expense of hospital-based services.

Central to the programme of reform is practice-based commissioning (PBC).

The financial risk of Payment by Results to the NHS, the delivery of the agenda for choice and plurality, and the aspirations of the White Paper, are all dependent on the successful implementation of PBC.

What is unclear within this reform programme is the government's vision for general practice, both in the short and medium term.

Many of the policies for the NHS are aimed at evolving general practice, but do we know how much needs fixing? While there is acceptance of the need for an improvement in GP estates, and possibly an improved efficiency in business management, there are issues about the delivery of services, patient registration and independent contractor status that remain open to debate.

This month the National Association of Primary Care (NAPC) held a meeting attended by the leads of all representative organisations that are likely to play a part in the future development of general practice, along with ministerial advisers, senior DoH officials, senior primary care organisation (PCO) personnel and a broad range of healthcare professionals.

The aim was to initiate debate on the future of general practice at the end of the 10-year plan.

The NAPC sees three essential components to general practice. First, the general practice unit, of whatever size, should remain the cornerstone of the NHS.

Second, despite the variation in contractual options open to PCOs and GPs, the independent contractor remains the key to the delivery of the majority of general practice. The independent contracting GP determines care for a registered patient without state interference, acting as the patient's advocate and navigator through the NHS.

Finally, list-based practice is essential to the survival of an efficient primary care system which acts as a gatekeeper to manage demand within the NHS. It was good to see a clear consensus at the NAPC summit meeting that current patient registration should not and will not be altered.

Also, a core developing function of practices will be to secure all services for the registered population by developing roles as commissioners as well as providers through PBC.

So, what would be the ideal vision for general practice?

If the expectations of the summit (see above) can be delivered, general practice can only welcome the reform programme with open arms, shape the future and determine its own destiny.

- Dr Kingsland is chairman of the National Association of Primary Care


The NAPC summit's expectations for 2010:

- rimary care is delivered locally, ideally from modernised premises with integrated IT functioning across health sectors.

- Services are responsive and fast, with convenient access to multi-disciplinary teams.

- Each general practice offers a choice of services based on the informed needs of patients registered with that team.

- These teams, through their PBC activity, provide an extended range of quality services and care in the least invasive of ways.

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