Primary care: a fading jewel in the NHS crown.

When Jeremy Hunt, the Secretary for State for Health in England, presented his 'New Deal for General Practice' in June 2015, he described general practice as the jewel in the crown of the NHS. Many general practitioners (GPs) though will not be reassured by his statement. Despite Jeremy Hunt's words of support, the future for GPs, their teams and their patients looks very uncertain. It is hard to see how planned levels of funding for the NHS in England can sustain a readily accessible, high-quality primary care service. It seems likely that primary care in England will increasingly be delivered by non-medical professionals, such as pharmacists, nurses, physician assistants and health care assistants. The acceptability to patients - and the impact on quality of care, patient outcomes and the other parts of the NHS - of this model are all unknown. An alternative scenario is that we gradually move to a 'two-tier' primary care system with those patients who can afford to do so paying to see a medically qualified GP.