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Renewal in general practice through professionalism

1 March 2006

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Mayur Lakhani
Chairman, RCGP

Already, 2006 is proving a watershed year for general practice – with the publication of the health and social care white paper, the chief medical officer’s report on revalidation and, this spring, the start of the third year of the Quality and Outcomes Framework (QOF) of the GP contract.

General practice, once again, is at the heart of the debate about the future of the NHS. The College welcomed the white paper, Our Health, Our Care, Our Say: a New Direction for Community Services, as it places GPs at the centre of the future patient-led NHS. This good news provides an opportunity for us all to have a greater say in improving standards and local services. Delivering the white paper is going to be a formidable challenge for PCTs, but the College will be calling on the government to ensure support is provided.

Last year, the College conducted its own public consultation in advance of the government’s white paper. We heard then that patients wanted their local general practice to remain at the centre of NHS improvements. The new white paper confirms the position of general practice as the best point of contact for routine and continuing care, and establishes plans to bring many of the services currently provided by hospitals into the community, with a new focus on the promotion of “health and well-being”.

The white paper also includes statements about a “refocusing” of the QOF of the GP contract. This contract was introduced in April 2004, with the QOF framework being an integral component. I have been disappointed, but not surprised, that the superb clinical results delivered by hardworking primary healthcare teams up and down the country have not been sufficiently valued or positively reported. I am sure that the QOF has led to more consistent and better clinical care for patients, but concerns have been expressed about the effect of the QOF on generalist holistic practice.

A contract should be seen as a way of bringing resources into general practice and constitute a payment mechanism. It is now time to think of a professional life beyond the new contract and escape the narrow focus that the QOF can sometimes engender. The flair and innovation of general practice must be nurtured and supported. This is because there is a continuing need to improve quality and safety – in its broadest sense – in primary care. But we need to better understand the influence of professionals’ motivation on performance in a primary care setting.(1) In 2006 and beyond, the health community will need to debate the big emerging question: what is the QOF for?

A recent report describes medical professionalism as “a force to improve patient care”.(2) The report states: “one of the major tasks will be creating (or recreating) environments in which professionalism can flourish”. And nowhere is this more important than in the environment of general practice, where the majority of the work of the NHS takes place. Good general practice is essential for patients, the NHS and society. Professionalism is making a comeback. It is the key to driving up standards.

Spring signifies new beginnings and fresh approaches. The white paper offers opportunities. General practice and the College are coming to these issues from a strong position. I know that, like me, you care passionately about patient care, quality and the values of general practice. But we must not become protectionist, and there is a need to face up to some difficult questions. I hope that general practice rises to the challenge of “raising the bar” when it comes to quality of care. We are winning the argument, and we command the support of patients.


  1. Lester H, Hobbs FDR, Sharp D, Lakhani M. The QOF: a quiet revolution. BJGP In press.
  2. Royal College of Physicians. Doctors in society – medical professionalism in a changing world. Report of a Working Party. London: RCP; 2005 Dec.