I’m struggling.

First there were GP consortia and the disbanding of primary care trusts (PCTs). Now we face the abyss. No one’s sure who’s going to lead in the Brave New World. All I know is that there will be large numbers of GPs of a certain age who, faced with pension uncertainty and more bureaucracy (for example, Care Quality Commission registration), will be pressing the button on the exit hatch.

I’m only 40. The dark days that lie ahead are unavoidable.

At a local level, historical GP relationships are sub-optimal (perhaps ‘fraught’ is a better description). This doesn’t help. The ‘them and us’ mentality of primary vs secondary care is unhealthy, and caught in the middle are patients who carry tariffs and not disease.

As a practice, we must become more corporate – but therein lies the potential conflict between ‘old’ GP core principles and a necessity to modernise. I’m particularly guilty of being slow to modernise and yet I’m still chronologically a young(ish) GP.

I guess security comes with size when it comes to survival in the future. Many single-handed GPs of a certain age will be retiring. Springing up are organisations keen to hoover up these practices and become mega-partnerships. It’s not new but it’s increasingly evident.

The balance of GP partnerships will change. To sustain our workforce we are looking at the career pathway that must evolve to keep our salaried workforce (if it is to remain) motivated and engaged. Whether this means a career pathway – based on merit rather than time – leading toward a partnership, we’re not sure.

A long list of recent applicants to a GP salaried position revealed a feminisation of the primary care workforce, as all but one of the eight applicants were women. The times they are indeed a-changin’.

I’ll end on something light: our new web-based software. It’s been four weeks now since we switched from our old version and it’s now been 36 hours since l called our IT lead to explain how to get out of “that screen”. One day I’ll look back on these days and laugh/cry – delete as applicable.

On a final topic, I see that dentists are going to be encouraged to do ‘medical health checks’. I’m not sure how this will work. I saw three patients with dental issues last week – each was registered with a different dentist and all three were unable to get appointments. Armed with my limited knowledge of dental issues, I thought it best not to attempt cavity filling. So I dispensed my best advice: try flossing!