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Dr Michael Dixon

OBE FRCGP

Michael Dixon has been a GP

in Cullompton, Devon for 26

years. He has been Chair of

NHS Alliance, representing

primary care, PCTs and

practice-based commissioners,

since 1998. His national roles

also include chairing the

National Life Check Board

and being a member of the

National Stakeholder Forum.

He is a Senior Associate of

the King’s Fund and Honorary

Senior Fellow in Public Policy

at HSMC (University of

Birmingham).

Other appointments include

Visiting Professor to the

University of Westminster

(Integrated School of Health),

President of the HealthWriters’

Guild and Honorary Senior

Lecturer in Integrated Health

at the Peninsula Medical School.

How will they

affect GP Practices?

(continuing from the Blair days) to

increasing competition and a larger

influence of the market in health.

The second is the financial recession,

which will see GPs as commissioners

and providers needing to make their

contribution to the £20billion that has

to be saved over the next few years.

How will things be different for the

average GP, practice manager or practice?

Whether leaders or followers, we will

all be able to have a say on local health

initiatives and be able to put the problems

in local services right. As future GPs, we

will also need to have an eye on the best

use of scarce resources. Individuals and

practices who spend more on referrals,

prescribing and diagnostics, will need to

watch things closer than they do now.

We will all have a vested interest in doing

so (needing to be an entirely transparent

vested interest, where it is personal and

financial) and our patients will need

to see themselves as interested parties

in terms of making the best use of

resources available.

Our everyday role in general practice

as providers of care will also change in

numerous ways. The most obvious change,

over the next few months, will be a much

closer working between those practices

who form part of a GP consortium. The

responsibility for quality improvement

will be largely delegated to GP consortia

by the National Commissioning Board

and peer pressure between and within

practices will become a far stronger force

than previously. Quality, safety, access and

costs will all be under review by our peer

colleagues, who are likely to be quicker to

identify and hopefully solve any problem

areas. The positive side of this will be

better and safer general practice but the

downside will be threatening to those

practices that don’t match up or accept

support to do so.The threat of expulsion

from the consortium and loss of the

practice’s licence will be the worst option.

Current NHS Changes

Not so many years ago, general practice

was undervalued, GPs were relatively

underpaid and the GP registered list

was, itself, under threat. Meanwhile, GPs

who wanted to improve local services

or make a real difference to the health

of their patients found themselves

stonewalled and excluded from the

corridors where decisions were made.

Today, general practice finds itself in

an almost opposite situation. With

Government recognising the crucial role

of general practice and primary care in

improving the health service and making

it more cost effective, GPs are now less

concerned about being excluded and more

worried about the huge responsibilities

that are coming their way.

These responsibilities are the result of

the recent HealthWhite Paper and

the Health Bill currently going through

Parliament. That this Bill is the largest (in

terms of size and words) ever presented

to Parliament is itself a mark of the huge

changes to come in general practice.

On the positive side, the Bill will enable

every GP and GP practice to improve

local health and services and extend our

role from individual patient advocate

to advocate of local health and the

local population. Some believe that this

enormous extension in our ability to help

local patients comes at too high a price

because our individual patient advocate

role may be in conflict with our role as

agent for the local population (doing

the best for the greatest number). No

one wants to be seen as an ‘agent of

Government’. In reality, however, the two

roles should be mostly complementary in as

much as GPs should have a better ‘menu’ of

services to offer in the consulting room and

overall more resources to offer each patient

if they have been successful commissioners.

GP commissioning apart, two further

factors will have an enormous impact on

general practice over the next few years.

The first is the Government’s commitment

Current NHS Changes

EIGHTEEN

Current NHS Changes