There is a storm gathering. The ‘GP’ contract, as much as a unified contract still exists, is about to be torn up and scattered to the four winds.

There have been numerous attempts to undermine the new GMS contract since almost the day it was born. And of course PMS is under attack from all angles.

Now the NHS financial crisis is going to give the powers-that-be the opportunity they have always wanted to start completely start again. What better excuse than the threat that the NHS could cease to exist if Draconian measures are not taken?

Anyone who read the recent comments of Jim Easton, the national director of improvement and efficiency, will be in no doubt that big changes are coming soon to general practice and there will be very little choice for practices on whether or not they participate.

Dare I say it, this is not necessarily a bad thing. Times of hardship can often be periods of great innovation. If it’s handled properly, can anyone seriously argue against a drive to improve quality and productivity within the NHS? There have been too many ill-thought out reforms of the system in recent decades, and perhaps what the NHS really needs is a truly new beginning.

The challenge for GPs, and all in primary care, is to take the lead while protecting the essence of the service, and perhaps the outlook will not be so bleak after all.