GPs must face up to difficulties and opportunities posed by New NHS

One year old next week, how are the New NHS reforms faring? They are either the best of reforms or the worst of reforms, depending on whose views you seek. They have brought the service to the brink of disaster or have positioned it for a triumphant breakthrough, according to which profession's prevailing orthodoxy you subscribe.

Listening to GPs, as prime minister Tony Blair gamely did last week - albeit via a live video link - conveys the unmistakable impression of calamity. The reforms have brought extra work, longer hours, too few resources, too much change too fast, according to speakers at the British Medical Association's GP committee conference. Despite such traditional GP whinges, vociferously expressed, this was one of the more restrained performances by GPs treading the political stage, complete with good-natured badinage swapped with Mr Blair between the diatribes.

Nevertheless, it may have led the prime minister to conclude that the BMA had fielded what one high-placed observer characterised as its 'head-banger tendency', in contrast to a leadership which in private at least appears much more conciliatory and realistic.

Certainly, the ritual denunciations of NHS Direct, however shrill, are doomed to be ignored.

Strong evidence suggests the public like it. They regard it as easing access to the NHS - messages the government is keen to capitalise on, as this week's plans to extend it yet again confirm. NHS Direct is here to stay; GPs will make a serious mistake if they choose this as a battleground in a covert turf war with nurses .

None of this is to deny the problems and challenges which the reforms pose for GPs. They must bear the brunt of many of the changes. But as Mr Blair would no doubt point out, they have been given a privileged position at the centre of the New NHS if they will only take advantage of it. No change is not an option: it not merely politicians' rhetoric to say that the NHS must modernise or perish.

In contrast, primary care group chief executives reflecting on their first year in office (see feature, pages 24-29) profess enthusiasm and optimism for the new NHS. No forces of conservatism here.

They have had to manage complex relationships and a heavy agenda, all to a hectic timescale and with limited resources. Formidable obstacles remain in the way for many. But there have been no catastrophic disasters, and the will to achieve lasting change and eradicate long-standing problems once and for all remains undimmed.

Mr Blair, take note: if progress is too slow, the fault does not lie here.