Interesting article and responses that return to two basic facts: there is underfunding of general practice and there is no consensus.
GP principals are becoming an endangered species, because who wants to take responsibility for a sinking ship? There are two hats for a GP partner, on the one hand to deal with the individual patient's clinical needs, and on the other to monitor, audit and improve the care services provided for the community (or at least for their registered list of patients). Current demands and lack of support means simply dealing with the former is taking more time than available. We are working in what could be considered "normal-illegal" (cutting corners by reading letters and results faster than probably we should; squeezing more patients into clinics, so far from the suggested 15 minutes' time current complex patients need, according to the RCGP; and having patients wait for weeks to see a GP for issues like a concern about a symptom that could mean cancer, so a 2 week referral could become a 6 week referral in the making, to name but a few serious examples).
The importance at present is not about consensus, it is not about what model to be applied, because we must accept that one path does not fit all. At present, what is important is that a career as a GP partner is challenging but not a risk, is enjoyable and not a constant worry, allows time to process the amount of information we deal with having appropriate time rather than working regularly at 100% capacity, having time to read and question previous decisions rather than doing the minimum requirements for appraisal, etc.
Every year more GPs are promised by politicians who aim to protect the NHS, but there is no delivery of them. GP practices are closing down around the country and more patients are put at risk because of it.
Before any consensus we need funding so general practice does not disappear. Then there will be time to discuss how we improve services on a bigger scale, sharing approaches among the different models available in general practice, adapting to the different communities and demands.
Competing interests: I am a GP partner.