Regular readers will know I have a two-brain relationship with general practice. One brain is reflective and takes me back to when I was eleven, sitting in the GPs dining room, that served as the waiting room; the mahogany table shining like glass as the early morning sun flooded though the bay window. Mum dared me never to touch the polished surface, least I left a fingerprint.

The consultation room, with the French windows opening onto a manicured lawn; standard roses, sentry-like along the snaking gravel path. He had a green house, we had a shed.

He wore a waistcoat and we had pullovers. He had gold cufflinks, we rolled up our sleeves. He had a garden and we had a yard. He had a car, we had push bikes. He had a wonderful warm voice and a reassuring smile; we had nothing but admiration for him.

As a very sick four year old, ten o'clock at night, Dad wrapped me in a blanket and carried me to the doctor's surgery. We had no phone but we had a GP who got out of bed and drove us to hospital. It was the first time anyone in my family had been in a car.

Yes, I have a romantic attachment to family practice and I still believe GPs should be part of the communities they serve; they should be family doctors, not factory physicians.

However, the other brain reminds me; I go to work before the surgery is open and come home long after it is shut. The 800 other people on my train will struggle to find a practice that is open, as will the thousands at Waterloo and every other commuter station. Primary care is closed to us.

This is a business model born of a fudge in 1948, when Aneurin Bevan struggled with a recalcitrant BMA, hell bent on defeating socialised medicine, that would leave GPs 'little more than common servants... '

The BMA is, still, the British Moaners Army. GPs constantly gripe about their workload, the pressures they are under and what a rotten job it is. I confess it is not without some justification that they say all this... but it is killing their profession.

GPs near retirement want to quit, young doctors want the glamour of Holby City and ER. Seventy percent of practices are too small, landlocked or with no chance of obtaining a planning consent to grow.

Primary care gives us 97% of first contacts for 8% of the NHS budget; based on tariffs, reimbursements and contracts that makes Ikea instructions look simple.

Despite all, Cameron talks of more care in primary care, more access, initiatives and ideas that ignore a workforce crisis, a funding disaster and the diehards facing burn-out.

But, and I take a breath; in 2009 according to McKinsey, the least productive GPs had 77 appointments a week whilst the average was 126. McKinsey said; if the worst improved, the same number of patients could be seen with 3,500 fewer GPs. Saving £400m a year. What ever happened to that!  What would they tell us today?

The BMA, have been busy with an interesting survey that has been largely over looked. Here are some top lines:

• Over 3 in 5 GPs support being able to own their surgery.
• Nearly half say their practice has not joined with any other practices or health organisations.
• Just under three quarters support the continuation of a national GMS contract.
• A large majority (86%) agree that telephone consultations are an effective way of consulting with patients but half are concerned about video or web consultations.
• GPs top 3 factors essential to general practice; Continuity of care, Trust and confidentiality, Holistic care.
• Top negative factors; Workload, inappropriate and unresourced transfer of work into general practice, insufficient time with each patient.
• Only 2% agree practices should offer 7day opening access to patients in their own practices.

There are lots more insights in this fascinating report.

This looks to me like a very confused workforce, struggling to do their best but not sure, anymore, what 'best' looks like, dislocated from the political classes who seem to want the opposite of what the workforce wants.  Something has to give.

GPs have been bullied, cajoled, bribed, shoved, drifted, wandered and tickled into moving away from something they should never have strayed from; family practice.

Slip sliding away....

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Just what is the future of the GP - come and join me in conversation with the boss of the BMA Dr Mark Porter. King's Fund 18^th June

Details Here.  

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