The intention of the reforms in general practice is to improve the quality of patient care. Unfortunately many of the suggested reforms are met with reactive defensiveness rather than reflective creativity. It is true that the government has not articulated its vision of the future of general practice well. Added to this individual GPs do not appear to have a shared vision that can truly invigorate and enthuse general practice, empower patients and allow barriers to be overcome. Some general practices will flounder if they do not adapt to the changes. Dialogue is not always about agreement but to get a better understanding of a complex issue. Conflict can be very useful and if we can discuss issues objectively, the focus can be on structure and development of better quality services for our patients.

I would respectively suggest that our local APMS contract is contributing to better primary care services and adding value. I work as lead GP for a community enterprise organisation (non profit making) that provides in hours and out of hours general practice services in the Mansfield area. The area has significant health and social problems and previously low levels of general practitioners (inverse care law). The establishment of the health centre and walk-in centre was met with antagonism despite the fact the our organisation tried to engage with local practices. We are supporting the values of the NHS, such as equity of access, universal provision and a good primary care network which remain important drivers within society.

Surveys of general practice report high levels of satisfaction. Despite this my daily narrative is that of dissatisfaction with previous levels of service and in particular access. GPs need to respond to the considerable good will that exists and reaffirm their compact with society. We need to get he message across that good general practice and relational care is an integral and pivotal part of the NHS and work collectively to provide better services. If we do not we will lose the support and influence. In the final analysis politicians respond to their electorate who have the potential to be our strongest advocates.