Primary care leaders have warned ministers that they will need to provide more money and tackle low morale as part of a full-scale review of the primary care sector.

The review will look at both the levels of staff and the way they work in GP surgeries and clinics and within other parts of the NHS, including hospitals and community services. It will report to ministers before April 2001 and will be managed by the Department of Health, guided by a group of external experts.

Health minister John Denham unveiled the details at the annual conference of the NHS Alliance in Birmingham last week, where he also called on GPs to carry out more minor operations to reduce pressure on acute services.

Alliance chair Dr Mike Dixon is one of the experts selected by the government to advise the review. He told HSJ that examining the whole primary care workforce 'made everything much more joined up'.

'I like the multi-professional approach, covering not just GPs and nurses, but also groups like community pharmacists and healthcare assistants, 'he said.

The review offered the chance of greater continuity and better career development, but he said it would have to tackle how to 'make general practice sufficiently attractive' and set aside more cash for primary care.

Dr Dixon said that encouraging older GPs not to retire early should be the review's top priority, alongside attracting back 'those on the periphery' such as locums, who do not want to go into practice full-time.

Not only were older GPs leaving, he said, but 'younger people are saying we want to live our lives and see our families'.

It would also have to take into account 'the stresses of the job', he said, given that 'commitment and goodwill were running a bit thin'.

Patients were often wanting more information and longer consultations, he said.'It's very frustrating not being able to do things properly. One aspiration might be to see how we can free up time for GPs so that they can do fewer and longer consultations, with more nurse triage.'

The NHS plan promises an extra 2,000 GPs by 2004 with 450 more in training. That number was a 'floor not a ceiling', said Mr Denham, adding that after 2004 more GPs were needed, and that training places would be expanded to meet this need.

He said he was 'impressed with the vision' of those working in primary care. According to the health minister, the plan, 'backed with a proper review of staffing needs, was the best possible way for all those involved in primary care to make that vision a reality'.

Clive Parr, chief executive of the National Association of Primary Care, which has been offered a place on the review team, welcomed the initiative.

It represented a 'belated recognition' that there was 'great concern' over the filling of places in general practice and GP retention, he said.

There were concerns that it was becoming more difficult to recruit practice nurses, said Mr Parr.

He said that offering job vacancies for practice nurses a grade lower than that held by the previous occupant and more nurses moving into NHS Direct could be factors working against recruitment.

See news focus, pages 11-12.