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Your views on hot primary care issues - Your Practice 2010

Grass-roots GPs share their views on the future path for general practice

As part of our 'Your Practice 2010' debate, we asked a straw poll of GPs for their views on whether practice-based commissioning (PBC) was a crucial factor in ensuring general practice would continue to thrive.

We also asked this group whether they agreed that GPs needed to get patients and the public more on their side if practices were to succeed in future.

Here are some of their views.

Do you agree that PBC is an important - or even a core - factor if independent contractor, list-based general practice is to prosper beyond 2010?

National Association of Primary Care (NAPC) chairman Dr James Kingsland thinks that it is. At a debate hosted in June by the NAPC, and attended by some very influential people in primary care, Dr Kingsland said: 'List-based practice is essential to the survival of an efficient primary care service ... a core developing function will be to secure all services for the registered population by developing roles as commissioners as well as providers through PBC.'

Your reactions

Doncaster GP Dr Lis Rodgers (above)
'I agree a GP is gatekeeper, co-ordinator and patient advocate. But let's not talk about GP providers in the same sentence as PBC - there should be a clear separation between the two and some practices have not yet grasped that.'

Berkshire GP Dr George Kassianos
'I could not agree more. PBC is the way for the future.'

East Midlands GP
'I agree with everything except the PBC bit. Most GP practices are too small to take this on and the rules will change with the next political whim, so why bother?' (Name withheld)

Bedfordshire GP Dr Mary Hawking
'Especially since the emphasis started changing from crisis management to preventive medicine, list-based practice has proved an effective tool.

PBC requires new methods of co-operation between practices to obtain an adequate population size and co-operation/support from PCTs.'

Leicestershire GP Dr Bill Spiegler
'I agree. I see advocacy as my key role. Having the cash helps a lot. Fundholding was good. PBC will be a poor substitute.'

Should GPs spend less time in the consulting room seeing patients and more time consulting their community to secure more influence over the future of general practice?

At the same NAPC debate, national clinical director for primary care Dr David Colin-Thome said: 'I think we GPs could have much more control over our destiny if we had the public on board. Perhaps we need to do extra work with our populations rather than concentrating on one-to-one care.'

Your reactions

Cambridgeshire GP Dr Ian Williams 'This is "Blair speak" rubbish. The one way to get the public on board is to be seen to be doing what we do well: one-to-one care.' Oxfordshire GP 'It is important to have positive involvement in populations - for example, with threatened closure of community hospital fights. We need the media on our side as well, with more positive statements about the importance of the local GP'. (Name withheld)

Lanarkshire GP Dr John Lando (above)
'GPs have always had the public on board. Unfortunately the public has a different agenda. GPs want to provide a high-quality medical service. The public wants an easily accessible nursemaid service.'

Bristol GP Dr Phil Yates
'It sounds as though Dr Colin-Thome may have lost touch with his public ... the area of conflict lies in the difficulty we face in offering personal accessibility when we are also trying to run the system.'

Hertfordshire GP Debra Gilbert
'I think that, post-Shipman, we have suffered in the public eye. We need to rebuild confidence in us and in our services. Patients need to be made aware that if a service is not provided, there is probably a very good reason.'

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