The intention of the reforms within general practice is to provide better quality of care for our patients. Unfortunately many suggested changes are met with a reactive defensiveness rather than reflective creativity from general practitioners. This is partly because the government has not always articulated its vision to society and the medical profession. Furthermore individual GPs do not have a shared vision that can enthuse and invigorate the future delivery of general practice and allow barriers to be overcome. Some general practices will fail if they do not adapt and learn effectively.

I work as Lead GP for a community benefit organisation providing in hours and out of hours general practice services in the Mansfield area. The establishment of the practice and walk-in centre was met with antagonism, despite attempts to engage with local practices and the fact we were a local not for profit organisation. The area has significant health problems and historically had low numbers of GPs for the population. (The inverse care law ) However our model of care is adding value and improving the medical and social care within a deprived area.

Even though surveys demonstrate high levels of satisfaction with general practice my daily narrative is that many patients are unhappy with the levels of service previously provided and in particular restricted access. GPs need to reaffirm their compact with society, empower patients and respond to the considerable goodwill that exists for us. If GPs do not get the message across that good general practice (excellent medical generalism, commitment to whole patient care and advocacy for our patients and communities) and relational care are an integral and pivotal part of the modern NHS we will lose our patient support. In the final analysis politicians will follow and react to pressure from the electorate who allow them to govern