Although the imposition of APMS clinics is government-inspired, I believe strongly that we GPs are contributing to our own demise. Indeed, it is only by recognising where we have alienated both the public and the government that we will be able to make changes and resist the threat.
The bottom line is that although patients rate their GPs highly as individuals, the practices we run are frequently disliked for their user-unfriendliness.
Firstly, we have not policed ourselves properly. A small percentage of our number are incompetent, lazy or addicted/alcoholic. We all know who they are; we would never let our families register with them. Yet we have allowed these inferior practitioners to continue misdiagnosing, mistreating and damaging patients without protesting, reporting them, or saying a word. Yet we say that 'we care about the patients'. (Do we really mean we care about our patients, but ignore the needs of the wider community?) Our lack of action has not gone unnoticed.
We have also not made ourselves properly available. Would we really let our banks treat us as so many practices do their patients, refusing to let us book an appointment a few weeks ahead? Or insisting that we spend three quarters of an hour first thing in the morning fruitlessly calling the appointment line, only to be told that today's appointments are now filled and to try again the next day? Would we treat our private patients like this?
Practices thought they were being clever in gaming the access targets, but patients are hugely inconvenienced. No wonder the hated Patricia Hewitt was adamant that some of our increased remuneration should have been ploughed back into patient care, buying in more doctor time and improving patient access. For once - just once - she was right.
Our refusal to discipline poor-quality GPs and our failure to respond to the real needs of a large proportion of our patients, coupled with our perceived (alleged) high salaries means we have turned the media and a large percentage of the population against us - not as individuals, but as businesses.
And that's not all. More next week.
Dr Lancelot is a GP from Lancashire. Email him at GPcolumnists@haymarket.com.