Sustaining general practice

Re-engineering and a new charter are needed for the next millennium

After 30 years of considerable achievement, the attractiveness of general practice as a career is again in question, and along with it the viability of primary care. The British government has placed great store on a primary care led health care system, but its rhetoric has not always been matched by clear consensus about development, concern for staff welfare, or adequate spending. There is widespread concern over job satisfaction, morale, autonomy, workload, bureaucracy, recruitment, and retention. A report from the BMA's General Medical Services Committee1 adds to several recent reports2 3 4 in suggesting ways of restoring the sparkle to primary care.

The committee's report reviews statistics and trends in the existing medical workforce, the supply of doctors, and the changing pattern of work and demand. Although general practitioner numbers have been rising, and at about 31000 are now at their highest level ever, this trend is threatened by a move towards earlier retirement, a rising proportion of part timers, an increasing proportion of …