'Take up the challenge of GP commissioning. The patients need you'

'When Dr Mark Porter became chairman of the British Medical Association last year, I warned him the job could be a poisoned chalice.' says Dick Vinegar. Photograph: Con Tanasiuk / Design Pics Inc.

Dear Dr Chaand Nagpaul,

Congratulations on your election as chairman of the General Practitioners Committee. When Dr Mark Porter became chairman of the British Medical Association last July, I warned him the job could be a poisoned chalice. Yours could prove to be the same, or worse, mainly because some of your members seem to be more hostile to change than the generality of doctors in the BMA. And you have to manage that change, not just, negatively, "to row back on damaging changes" imposed by the Department of Health.

Clearly, the most important change is the extra power given to GPs when the former health secretary Andrew Lansley replaced primary care trusts with GP-driven clinical commissioning groups (CCGs). This needs overseeing by you because, clearly, as in other professions, some GPs are good at managing, while others are definitely not. I see your role as nudging them all along, to give encouragement to the participating GPs – and, dare I say it, the patients. You must, in the nicest possible way, get the right GPs to invigorate the CCGs. What you must stop your members doing is throwing up their hands and moaning "I didn't become a doctor just to do this administrative stuff." Take up the challenge of GP commissioning. The patients need you.

Another thing patients need from GPs – particularly octogenarians like me with multiple comorbidities – is continuity. I have been banging on about this for some months now. We, your core customers, need to trust someone in the NHS to fight our corner over time. The NHS is getting more and more fragmented and confusing, while we are getting less able to understand complexity. Our GP is the only friendly face available to help. We need someone to recommend the right treatment, track our progress through the hospital, and to make sure that if we fall ill at night or weekends, that the out-of-hours service is fit for purpose.

I was worried when I read in the Francis report that the GPs in Mid Staffordshire did not sound the alarm about the dreadful treatment their patients were suffering in hospital.

And I was shocked to hear quite recently that, in 2004 the Labour government had done a deal with GPs, whereby the GPs had renounced all responsibility for out-of-hours care. (I have, incidentally, done a straw poll among my octogenarian contemporaries, and have found that the majority were as ignorant and shocked by the renunciation as I was. Among them was an ex-chairman of a large mental health trust.)

You may accuse me of hankering after a long-gone golden age of "family doctoring", but I am concerned that the modern day GP, run off his/her feet by the demands of the DoH and of ageing patients like me, has renounced continuity, and is turning into somebody more like a hospital doctor, who treats episodic ailments, washes their hands and goes away.

General practice is a noble profession, with continuity of care as the jewel in its crown, and my own GPs are unstinting in their care of myself and my contemporaries, in or out of hours. But I worry that some of your other members, particularly the noisy political ones, do not see things this way.

Jeremy Hunt has said he would like to see out-of-hours responsibility returned to GPs, and has been vilified for saying it. However, it seems to me that just by saying this, he has offered you an open goal. You should agree, and tell him what it would cost in terms of extra GPs. You have said that you "will fight for general practice to get its fair and increased share of the NHS cake". This is your opportunity. It should not be too difficult to persuade him that money spent on GPs goes further than money spent on A&E departments. And that GPs are better at triage than non-medical 111 staff armed with dodgy triage software.

There is a real chance right now to make a big difference for GPs, and more importantly, your patients.

Best of luck,

Dick Vinegar

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