As if this weren't bad enough, we have to do it all at express speed, forced by the government to make ourselves urgently available, even to those with minor or self-limiting illnesses. We are expected to take over low-level hospital work, and we act as a valuable gatekeeper to secondary care.
You might have thought that DoH would value the work we do. Not a bit of it. It has always considered GPs to be failed hospital doctors and treated us accordingly. Perhaps this explains why GPs have been so signally ignored by the present government. In every big project, we have either not been consulted in the first place, or else our point of view has been ignored.
Just look at the damage this has caused. No NHS project created by this government has functioned properly when designed without GP input. Connecting for Health is about to founder over medical confidentiality; Choose and Book has been a disaster; NHS Direct is not cost-effective - it takes a nurse and an IT program 20 minutes to do what a GP would carry out in three, and even then 70 per cent of patients are referred back to their GPs. Where organised by non-GPs, the out-of-hours reforms have reduced the quality of care, cost the NHS vastly more money and inundated A&E departments.
Now the government is trying to reorganise primary care itself without proper GP input. The Darzi surgeries will undermine the continuity of care in the patient-GP relationship and, by paying peanuts to salaried GPs, discourage the brightest new doctors from taking up a career in general practice. The most difficult job in medicine will in future be performed by those less fitted to do it, under conditions that automatically minimise the effectiveness of their involvement.
When will the DoH realise that we GPs are experts in our own field, whose advice has to be taken seriously? Only when we are gone, I fear.
Dr Lancelot is a GP from Lancashire. Email him at GPcolumnists@haymarket.com