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At the same time, practices will become

far more transparent in terms of their

performance measured by the Quality

Framework and other measures. Patient

involvement in practices (via practice

patient groups and the like) will become

standard as a means of showing the

practice is listening to its patients. Such

groups will also be a means of support,

when difficult commissioning decisions

need to be made. They may also be

needed as regulation tightens its hand

and GP practices fall under the Care

Quality Commission.

As well as being more accountable,

general practice will find itself in a more

competitive environment. Thirty years ago,

each general practice would watch what its

competitors were doing and try to match

them. Those days will return, especially with

the opening of GP boundaries (proposed

by both this and the former Government)

and with private providers entering the

market. The competition to provide and

to show that you provide the best service

as a commissioner and a provider and in

terms of patient experience will become

much greater.

Competition will encourage diversification.

Just as the corner shop has given way

toTesco, patients are likely to want

more services ‘under one roof ’ with

many practices offering ‘GP plus’ such as

pharmacy services, Citizen’s Advice, self-

care and a range of different therapies.

As commissioners, we are likely to want

to bring an increasing range of previously

hospital-based services into the community

and general practice. This will offer further

opportunities for diversification and offer

increased income and stability for local

practices though, once again, they will

need to be absolutely transparent, where

self interest is involved. In many cases,

practices may overcome this by forming

social enterprise or community interest

companies that manifest their commitment

to the local community.

In parallel with our role as health

commissioners, future GPs and practices

are also likely to be much more involved

in providing health as well. In the shop

window of each general practice there

is likely to be a far greater emphasis on

personal and community health and

helping people to self-care. This will

hopefully be encouraged and funded by

the Health and Wellbeing Boards of the

Local Authorities. General practices ahead

of the game will become demonstration

sites for health – nutrition, exercise and

improved wellbeing – working in closer

contact with their local communities and

other health-related agencies.

With our extended role, future GPs are

likely to work even harder in a more

challenging and complex environment.

As far as patients are concerned, future

general practice should be safer, better

and more cost effective. Traditional

values of general practice such as

personal relationships and continuity may

also be valued higher in a competitive

environment, where the views of patients

count more. For GPs, practice managers

and other practice staff, life should be more

satisfying because we will be able to do

so much more. Our extended role should

also enable us to retain status and income

by being the most important and central

cog in the NHS’s future. That future,

because of the current changes, will be

largely in our hands.

Current NHS Changes

NINETEEN

Current NHS Changes