I was interested to hear Richard Vautrey on the Today programme on Thursday 9^th of October.  John Humphrys was questioning him about the Health Select Committee report of the new GP contract put into place just four years ago. Richard Vautrey, as befits a future Chair of the GPMC boxed very clever and was forthcoming neither in admission nor denial. The report indicated that the Government had not gained value for money but what JH teased or taunted Richard about was the reports of GP incomes of £140,000. Richard Vautrey was careful to inform that they were discussing GP Principals’ incomes. Though I think the subtlety of this message would be lost on the listener, the distinction GP Principal vs. other lifted a little fog from my mind.

Our new contract’s gestation was at the time of a relative famine of doctors entering general practice. In fact one of the admitted purposes of the new contract was to make General Practice a more attractive career.  With the increase financial resource going to General Practice the new contract delivered well on this particular aim.

In those years of relative famine, in many urban practices should a GP leave or retire he or she was difficult to replace. If there was no replacement not only would the remaining GPs have more work but the practice income would fall due the loss of the exiting GPs allowance.  Such were the strains that other doctors close to retirement gave careful consideration to finishing their careers prematurely. There were rightly fears of a domino effect; one toppling followed by another then another then another.  The new contract sought to address this issue by abolishing the doctor’s allowance, while maintaining even enhancing practice income in alternative ways. It worked so that should a practice of say 10,000 patients and six doctors lose a doctor the total practice income was unaffected.  In these circumstances for the remaining partners it now made admirable economic and business sense to employ not a GP, but say a nurse practitioner or practice nurse, thereby increasing the remaining partners’ income.

Now here’s the rub.  The unintended consequence is that over the next few years that the number of GP Principals will fall even as the number of GPs increases.  We shall have increasing numbers of GPs employed not just by large business corporations but by other GPs.  This is likely to force the question to the lips of Mandarins in the Department of Health “exactly what are GPs for?”

“It’s the end of General Practice as we know it”.  I fail to remember the number of times I have heard this mantra of the distressed somewhat paranoid fellow colleague, but I confess to some little worry about the final answer to the above question.

I was recently given a small, attractive Victorian book, “A Doctor of the Old School” by Ian MacLaren.   This tells tales of a country doctor working in the Highlands of Scotland. Not only was he wise and learned but he was integral to the life of the villages in which he lived and worked. For most of us this idea of geographical reference has been lost.  For many of our colleagues the family is becoming equally remote.  If this depersonalisation continues to the point of anonymity, then just what is the role of the GP?

The moral to this blog, is the fundamental importance of retaining the value of the Family Doctor, for without them GPs will be increasingly replaced with cheaper alternative bio-technicians.