So, we’ve had the emergency budget as well as a debate in this week’s British Medical Journal (BMJ) regarding the continuation of QOF or not – these are difficult days with difficult decisions to be made.

I’m not sure that any of us can fully appreciate the level of debt that we have accumulated in this country. It won’t really be that obvious until we really do see services that we’ve taken for granted disappearing.

Some things do need to change: the multiple layers of decision making, the innumerous managers guiding in numerous initiatives with dubious titles and impenetrable reports need to end.

We have no right to expect to escape cuts, although health may not be the biggest service to be targeted.

As I sit in surgery, I wonder where the inefficiencies lie. Then I click on the PCT homepage in search of answers. It’s quite easy to be cynical as one looks down through the departments and wonder at the different titles. Perhaps I do a disservice to those that I have no knowledge of, perhaps I am naïve? Or could efficiency drives lie here?

As a GP, I have to provide value for money. I feel the QOF targets should remain, but should also strive for greater levels of care. We must look at our own internal systems, look at paper trails, meetings, surgeries that we offer and availability. We must improve liaison with secondary care so that we can facilitate better care at home to our chronically ill patients.

We’ve not given up on new premises, but in the coming age of austerity, we need to justify our application. We need to provide more services and greater accessibility. We are stakeholders in our own country’s future.

On a lighter note, the sun is out and we are distracted from our own precarious position by England’s World Cup trauma. The registrars have not collided with any cars in the car park lately and we have selected a new partner.

Our senior (age wise) partner is retiring at the end of August and we held interviews last week. We were organised; we knew what we wanted from our interviewees (makes a change) and after some overnight deliberation decided on our new partner.

We have also employed at least one new salaried partner, as our successful applicant for partnership was an internal candidate. So, in this age of uncertainty at least we have managed to retain our full compliment of partners.