Dear Mr Streeting,

Thank you for your recent open letter of 27th November,with its praise for the continued innovative,hard working nature of the GP workforce in this country.

As you say,there are many positive ways in which this government have supported general practice since elected and it is heartening to hear that the intention is to continue to do so.

Progression and change has always been necessary in the health service since inception and that is wholly recognised by the profession in order to maintain and improve the quality and in cases the quantity of care available for patients.

Change is never easy and should involve robust consultation and listening to genuine and informed concerns about the meaning of that change and possible consequences both for patients in this case and the workforce proposed to provide that change.The increase in patient demand still far exceeds capacity,despite the already acknowledged increase in achieved consultations.

It is noted in your letter that recent negotiations with our elected representatives in the BMA have been challenging and disappointing,but it is important to note that these representatives,Dr Katie Bramall,Dr David Wrigley,Dr Samira Anane and Dr Julius Parker are simply communicating the nature,extent and depth of feeling that currently exists countrywide within the current GP workforce.They have and will continue to have our full support and backing and one has to ask why things have been so challenging.

As much as it is important for the profession to embrace change,it is also critical that the government listen to,hear and consult properly on genuine concerns for safety of both patients and the people providing and expected to provide a high level of care for them.

Pretending that adequate consultation has happened and using this as a basis to impose is not constructive and is inevitably going to lead to resentment,bad feeling and  breakdown of what once were healthy,productive and equal relations.

The profession fully accepts respect as essential but is equally keen to point out that this respect has to be mutual and works both ways.

As you say,despite some challenging and disappointing aspects to consultation over the last year,the GP workforce in this country is also prepared to move fowards with the government on the basis of mutual respect with extremely valid concerns being listened to,heard and discussed fully.

We hope that this point will be taken on board at this point and anticipate honest and open discussion and negotiation to enhance and progress patient care going forwards.