Over recent months GP has carried a debate on the challenges and rewards of primary care in 2010 and beyond.
This week the wider profession has had its say in a GP survey and it paints a mixed picture.
Headline results highlighted the expectation of an end to the UK-wide contract and concerns over the decreasing influence of GPs in the upper echelons of NHS decision-making.
Many of the issues raised by GP’s commentators in recent months loom large.
Former GPC chairman Dr John Chisholm spoke of the need to think strategically to stave off private providers. GPs agreed with him, rating private providers as the biggest issue facing GPs in the next few years.
Dr Alan Maynard, professor of health economics at the University of York, warned that private providers will ‘customise activity to maximise profitability’. For GPs the second-biggest issue was profitability.
As Lanarkshire GP Dr John Lando warned that the public wanted an ‘easily accessible nursemaid service’, the loss of professional status came out as the third-biggest issue in the survey.
However, amidst the worry over these issues, the survey results also showed divided opinions, with optimism woven into some of the more negative views.
For example, the loss of professional status was the single most pressing concern for the highest number of GPs — 24 per cent.
But it only came third on average because 15 per cent saw it as the least pressing of the issues presented, also the highest proportion of the 10 options.
Figures were similarly divided on practice-based commissioning (PBC). On average it was only the sixth most important issue, but the same number (9 per cent) rated it the most important as voted for maintaining profits, which came second on average.
Then there is the pensions issue. Although few thought this presented the biggest problem (7 per cent), just 2 per cent saw it as the least pressing issue, the lowest proportion of all 10 areas.
GPs do not see pensions as the single most urgent issue, but it is right up near the top for most of them.
This means that overall pension reform is seen as the third most pressing issue.
However, at the bottom end of the list there was some unanimity. In spite of recent BMA surveys and mounting pressure over LIFT schemes, just 1 per cent thought premises development was the most urgent issue.
Second from the bottom was a possible end to practice lists. Only 3 per cent saw this as the number-one issue.
So does the GPC see the future of general practice facing the same issues as the GPs it represents? The answer is both ‘yes’ and ‘no’.
A GPC view
GPC chairman Dr Hamish Meldrum believed that privatisation might have risks, but it was not in itself a problem, whereas practice lists were all important.
‘Privatisation raises risks of fragmentation which is a problem, but I have fewer worries about this as long as GPs can compete on a level playing field.
‘The main problem I see, which could be affected by fragmentation, is being able to maintain the values and ethos of general practice.
‘Things such as maintaining a patient list are a core aspect of that as well.
‘I am the eternal optimist,’ he said. ‘But it’s also my job to be a realist. ‘It’s too easy to focus on the downsides — we also need to promote what’s good about general practice, of which there are many things.’