By the time this postcard arrives, the United Kingdom will have a new government. One of its major tasks will be to wrestle with the problems of the National Health Service (NHS) in a tight financial climate in which it will be difficult to provide significant increases in NHS funding for the next 3 or 4 years at least. The NHS has enjoyed a massive injection of cash over the past 5 years, and although many aspects of the health service have improved, including access to secondary care, cancer care and waiting times for treatment, there are still many areas of concern. The consequences of membership of the European Union include free movement of heath care professionals, which has led to poorly trained and linguistically challenged doctors working dangerously long hours in the UK; and the European Working Time Directive, which has raised serious concerns about the adequacy of medical training and patient safety. In the cities, the perverse incentives for general practices to employ salaried staff, rather than profit-sharing partners, threatens the survival of the partnership system.

The political parties have proposed a range of policies aimed at protecting NHS funding and maintaining “front-line” services. These include, predictably, reducing bureaucracy and waste, and working more efficiently. Ideas to achieve this include: abolishing primary care trusts (PCTs) and replacing them with locally appointed and locally elected health boards; scrapping the disastrous and hugely expensive centralised information technology project, “Connecting for Health”; and reducing by a third the amount spent by the Department of Health on advertising and publicity. One of the Labour Party’s ideas was to rename the Department of Health as the Department of Public Health, emphasising the importance attached to preventive medicine and health promotion. The Labour government has also set great store by its QIPP (Quality, Innovation, Productivity and Prevention) program, much of which is designed to encourage collaboration between primary and secondary carers, particularly for patients with long-term conditions. This is welcome, because consultants and general practitioners seem to have drifted apart again in recent years, perhaps partly because of the way that funding at PCT level encourages a competitive rather than collaborative approach to service design.

Perhaps the Labour government’s most controversial proposal — and one definitely not designed to save money — was to introduce a state-funded social care system, along with arrangements to support the costs of end-of-life care for the elderly. It is difficult to see how, in the present financial context, such proposals can be entertained without a massive rise in personal taxation.

The 2008 inquiry led by Sir John Tooke1 recommended an extension of training for general practice to 4 or even 5 years, and it was disappointing to hear recently that these proposals have not been supported by the body overseeing postgraduate training in the UK. This is a great shame, because not only is the UK out of step with GP training in many other countries, but also the increasing “secondary–primary care shift” in the focus of care means that general practice is being asked to handle patients with more and more complex conditions. This requires adequate, often additional, specialist-based training, as well as more time in practice, and may also have implications for undergraduate teaching. After all, about half our qualifying doctors become GPs, and the task of general practice is becoming more demanding by the year, as GPs are required to deal with populations with changing demographic, ethnic and cultural characteristics, not to mention new infectious diseases and new twists on the old, non-communicable ones.

Finally, general practice may need to take a hard look at itself. The new contract and the introduction of the Quality and Outcomes Framework resulted in considerable increases in income for many GPs. The withdrawal from out-of-hours responsibility, along with fragmentation of continuity of personal care, are considered by some to threaten the core values of the discipline and may not have done much to endear us to our patients. Proposals are welcome for GPs to resume responsibility for providing out-of-hours services, to become more engaged in local service redesign and delivery, and to reinvest efficiency and innovation savings in their practices.