Speak up before change gets out of hand

If even half the ideas currently on offer about the future of primary care come into being, general practice is about to experience a level of change similar to that recently undergone by the music or phone industries.

In other words primary care could be virtually unrecognisable as the same service in five to 10 years.

In the past week alone we have seen reports on out-of-hours and 'care closer to home', and more from health minister Lord Darzi on health reform, while the health secretary continues to worry the extended-hours bone.

The effects of the plan to move more work from secondary to primary care provide one of the starkest examples about how the landscape will change. A report from the National Primary Care Research and Development Centre reveals that these new care pathways will require a huge increase in the numbers of GPSIs. The report's authors warn that this could have a significant effect on skills and the capacity of GP services. In fact it could see some GPs becoming full-time GPSIs; this would, effectively, be the creation of another category of doctor because they would no longer be GPs in the commonly understood sense.

Meanwhile, if the authors of other reports have their way, the remaining, now overstretched, GP workforce will be opening from 8am to 8pm while operating more out-of-hours services for acute conditions to take pressure off A&E.

On the other hand, in this vision, diagnostic services and pharmacies will also be providing a 24/7 service alongside GPs. But where these services are offered is also under debate, with Lord Darzi admitting that he has not considered the practical NHS estate issues around his polyclinic plans.

So, is this the brave new primary care world you want? Will it improve health outcomes? Are these even practical proposals? The RCGP has recently offered its vision of the future but it is no longer enough for GPs en masse to sit back and wait to see what happens. If the profession does not make its views known, and fails to shape its own future, today's GPs could soon feel like a 45 in an iPod age.

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