Comment: Entrenched attitudes towards 'consumer' demand are shifting at last

Published: 13/06/2002, Volume II2, No.5809 Page 17

The UK's 43,000 GPs start to vote this week on a new contract which, if agreed, will introduce massive changes unthinkable even a decade ago. The new contract framework, negotiated by the NHS Confederation on behalf of the government, has been signed up to by health ministers in all four UK countries. It proposes to relieve GPs of responsibility for out-of-hours care, unless they wish to keep it, and to give much greater powers to managers in primary care organisations. Unlike now, when the health secretary holds a contract with individual GPs, the new contract will be between the primary care organisation and the practice. The new contract will also offer the option for GPs to become salaried.

The introduction of NHS Direct, and walk-in centres, in the face of some opposition from the British Medical Association, were visible signs of the government's determination to make primary care more convenient to the consumer, which seems to have shifted some entrenched attitudes about provision.

The news that most of the country can now offer access to a GP appointment within two days (cover feature, pages 22-25) seems like another milestone on the modernisation journey. Even if the real figure is lower than that indicated by primary care trusts' snapshot surveys, and common sense suggests it may well be, and even though much of London is missing the target, there is still a sense of GPs tackling access. It is heartening to see practices giving attention to demand management and effective use of skill mix. How many in the profession were looking at flexible provision 10 years ago?

But it is early days, and the drop in the proportion of practices meeting the government's two-day target suggests a loss of momentum. It will be interesting to see what the next couple of surveys reveal as they will coincide with many PCTs getting established and struggling with premises problems and shortage of staff. The target of 90 per cent of practices offering a GP appointment within two days by March 2003 will still be a considerable challenge for practices in many areas. But it is to be hoped that primary care organisations will encourage the mood of cautious optimism in general practice which the new contract heralds. And that GPs will continue to concentrate on access even if the 48-hour target does not form part of the contract. l