The journey of a thousand miles begins with a single step

"Three score and six years ago, our fathers brought forth in this country a new health service, conceived in liberty, and dedicated to the proposition that all people deserve free health care and freedom from want.”

OK, excuse my crude theft from Abraham Lincoln's Gettysburg Address, but the concept was a novel one unrecognised anywhere else in the world in a developed nation at the time. We were post-war, exhausted financially, and surviving on loans from the USA. Forgive what might seem hyperbole to some, but I feel the creation of a health service that would free a nation from illness was a milestone in history to challenge the Magna Carta in terms of historical significance.

Today, however, nearly seventy years on, the NHS, in one of the wealthiest nations on earth, is collapsing from spiralling demand. Its foot soldiers in the front line, GPs, are being decimated in a battle of attrition that seemingly government, the press and the public are colluding in that will result in the destruction of a once proud profession.

Is there any hope for us, or is the battle already lost? We believe there is. It is time for General Practice to stand up, fight back, and say "Enough is enough". It is time to tell the government and the press to get off our backs, robustly and firmly.

We need to train new GPs to be patient-centred, but to have the freedom to know when to say "No" to act in their patients' best interests, but equally in their own. General Practice in the UK is being consumerised, packaged and prepared for sell off, and too many of those who purport to represent us have vested interests in that outcome.

It appears our Royal College is not preparing new GPs for the workload intensity they are facing on qualification, and as a result many lack the resilience and burn out within a short space of commencing their careers. This is a sad outcome for some of our best and brightest medical graduates. So what are we going to do about it?

We are a small but committed group of GPs with a wide range of experience who know how to survive in this harsh clinical climate, how to say "Yes" and "No" with assertiveness to patients and to the powers that demand too much of us, know when to act to protect our patients, and just as importantly, know when to act to protect ourselves.

We are not a replacement union for the BMA. Nor are we a fledgling college to rival the RCGP. However, we aim to influence both and change their mindset, the better to protect our profession. We will offer our experience to train new GPs in resilient practice, offer a support network to help answer those tough challenges we all face, whether new GP or old hand. We will influence and challenge robustly the people who are supposed to represent our interests but too often get lost to the “dark side” to serve only theirs, once power is acquired.

Can we achieve it? We believe we can. Too many will write us off initially as being a small and insignificant pressure group, as "Remedy" was initially perceived by some when it formed in response to the junior doctor training fiasco. It will take a while, but as the Chinese philosopher Laozi said, “The journey of a thousand miles begins with a single step”. We are taking that first step today.

Our influence and support base will grow, as we draw in new colleagues trained in “resilient primary care.” Change will happen if we make it happen.

Don't believe us? Have you already lost hope that we can make things better? Then think about what Margaret Mead, the anthropologist wrote: "Never underestimate the power of a few committed people to change the world. Indeed, it is the only thing that ever has."

Alan Woodall, GP

Powys, June 2014.