In April 1984, a year sacred to a generation of futurologists, we proposed in a letter to the JRCGP, as it was then called, that GPs should be rewarded by a payment based on practice performance.
Exactly 20 years later, we have the new GMS contract. We were wrong about consultant colleagues being involved in the quality and outcome framework, but our suggestion that the seniority pay was not compatible with a compulsory retirement age has been born out, albeit not in the anticipated direction.
We feel justified, therefore, in looking forward another 20 years.
What will life be like in April 2024? Will illness be simply be the lack of wellness in an increasingly complex society, will variant CJD have proved to be the new AIDs, or will our day be spent dealing with the consequences of violence and social disintegration.
Some predictions are easy. The epithet ‘new’ will have been dropped from GMS sometime previously. In fact the whole contract will have disappeared. Following the GP retirement bulge around 2010, the majority of patient contact will be with others. Doctors will deal only with investigation, care planning, and obtaining informed written consent to treatment.
By 2024, following several more reorganisations of the NHS, remaining GPs will be employees of a single body managing the whole of the patient's pathway through primary and secondary care. They will split their time between hospital medicine and primary care.
With a salaried, predominantly female, shift-based workforce, the average practice size will be much larger, with a consequent move from doctor-owned premises into combined health and social service primary care centres.
In order to survive, the RCGP will become the Royal College of Primary Care Practitioners, or perhaps, reflecting wider social change, the CPCP.
The GMC will be long gone, professional standard setting being the remit of a NICE/CHAI derived quango. Reaccreditation, not even under discussion in 1984, will be a human resources function.
And a fully integrated electronic patient record will be just months away.
Doctors, as we know, are respected by their patients for the ability to predict the course of their condition.
Ironically, although the future of general practice itself is entirely transparent, our crystal ball becomes very cloudy when we try to see who will be around in 2024 to check the accuracy of our predictions.
- © British Journal of General Practice, 2004.
