General practice's last stand

EDITOR,--As the author of the discussion document from the BMA's General Medical Services Committee on core general medical services and the classification of activity by general practitioners,1 I wish to respond to D P Kernick's attack on the document as “a milestone in our professional decline.”2 Kernick, who targets not only me but also the president of the BMA and the chairman of its council, portrays the discussion paper as futile, misconceived, anachronistic, and the product of a bunker mentality. While Kernick purports to have positive ideas about the future of general practice, the article seems to be singularly negative and lacking in faith.

The author's case seems to be that doctors should now no longer be paternalistic but should work in partnership with their patients; that the quality of care should be improved; and that general practitioners will increasingly have to develop business and managerial skills and a role in assessing need and in planning, managing, and delivering services accordingly. How Kernick conceives that I, the GMSC, or the discussion document espouses contrary views I cannot imagine.

Kernick's contention that “virtually all change has been imposed from without and almost universally characterised by professional antagonism” rewrites history with a vengeance. I would contend that the three greatest developments in general practice since the inception of the NHS have been the introduction of the Cameron contract in 1966, of mandatory vocational training in 1979, and of commissioning of care in 1991. The first two of these developments were the direct result of pressure from general practitioners, in which the GMSC took a leading role. Only the most recent development met with opposition from most general practitioners before its introduction, and, whatever the different attitudes to fundholding that remain, the commissioning role that is available to all practitioners as a result of the purchaser-provider split in the health service is now almost universally welcomed.

Kernick also contends that doctors are being offered large handouts of cash to reward incompetence and encourage early retirement. No such scheme is now to be implemented, but the debate about how to address poor performance should be conducted in less pejorative terms.

The concept of the core content of general medical services, which Kernick reviles, has been developed because of the realisation that general practitioners' workload has been increasing,3 often without any additional remuneration and in the absence of any practical mechanism for them to identify, contract for, and secure remuneration for new services. Far from being a negative concept, it is intended to allow the roles of general practitioners and of primary health care to expand and develop, so long as the necessary resources to allow such development are provided. In attacking a strategy that is intended to deliver fair rewards to general practitioners in the future Kernick is out of touch with colleagues.