Dr. Ronan Fawsitt:

Again, that would be a matter for negotiation. We really do need a GP contract as a matter of urgency to ensure clarity. What I am talking about is a GP-led team of fellow professionals who share the task of providing care in a meaningful way over time. If I wanted to open a new stroke unit in St. Luke's hospital in the morning - we have one and it is probably one of the best in the country - I would go to one of the senior clinicians to ask how I should proceed. I would then bring in the manager and, using the evidence and funds available, ask what we could do. I would then do what I could. There has been no such enthusiasm in the area of primary care. We are the experts on what the clinical pathways should be. Where there are not enough clinical pathways, we can discuss the approach to take with our colleagues as part of a bigger team.

Having GP-led primary care services is not just about the clinical pathways but also about the care pathways. It is about joined-up thinking. If we were to develop a health service in the morning, would we pick an airline model? I would because everybody would be equal. If one piece of the puzzle were to fall, the whole thing would fall down. The pilot is not the most important person in the airline; the passenger is. We really need to focus on the patient's journey.