Domhnall MacAuley: The future of general practice….is private

Domhnall MacauleyWhat will happen in general practice…now that we have so many part time portfolio doctors, practices where the focus is on performance related income, increasing delegation to practice nurses and nurse practitioners, and patients often seen by someone who has little knowledge of their past medical history? Out of hours care, for at least 8 of 24 hours each weekday, weekends, and bank holidays is provided by contract doctors. Midwives provide maternity care, health visitors define their own role in routine paediatric care, palliative care is offered by specialist units, and a number of hospital clinics provide community outreach. You may see someone different each time you go to the surgery. The traditional GP providing personal, primary, and continuing care will soon be extinct.

When you and I develop our chronic illnesses we may tire of recounting our medical history to endless different professionals who focus on segregated parts of our health and know nothing of our past. If we decide we’d like to see the same doctor who knows us and our family, where would we look? And, how much would we be prepared to pay for this type of care?

If I were a young GP, who believed in the traditional values of general practice—of personal, primary, and continuing care, accessible 24 hours a day, I would invest heavily in premises and open up in private general practice. Primary care, as we remember it, is unlikely to be available in the future. People know the value of good care and as the middle aged, middle class, become disillusioned with UK primary care, they will weigh up how much they are prepared to pay for a real GP. In the US they call it concierge medicine—private general practice to us. Two tier inequitable healthcare is coming but no politician or professional organisation dares to say it publicly.

Domhnall MacAuley is primary care editor, BMJ.