GENERAL practice, and its place within the primary care landscape, is changing. Its workers, too, appear to be changing. The old pattern of lifelong continuous service provided by one person to one population is breaking up, and what will emerge instead is uncertain.
The old model of lifelong partnership has been likened to a marriage, and like a marriage may be good or bad, depending more on internal practice dynamics than the national context. As in marriage the commitment required to maintain a long-term relationship, and to resolve problems such as unequal partnerships, may be lacking. General practitioners (GPs) are becoming quicker to separate from practices when there are problems.
This degree of freedom of movement (or instability) would have been unusual previously. Now that it is possible, and indeed that change may be viewed positively, GP turnover is increasing. This implies that there can be a change in how GPs relate to the time frames of their role. In particular, although we may express belief in the value of continuity of care we may not be willing, or feel supported, to deliver it now.1-3 The short-term focus of much National Health Service (NHS) management is clearly mismatched with the traditional long-term focus of general practice.
Just as in the wider society the default relationship is no longer a stable marriage, so in general practice we are seeing an emerging range of relationships between GPs and their work. The spectrum is now from lifelong partnership (GP principals) to serial monogamy (commonly, salaried doctors) to …