The prime minister today pushed ahead with his ambitious primary care reforms, announcing plans to boost GP numbers and giving them more money and power in a bid to avert a damaging doctors' revolt in the run up to the general election.
Tony Blair unveiled a £100m package of incentive bonuses for family doctors in England and Wales who meet locally agreed performance targets - an average of £10,000 per GP practice.
He also promised 550 more GP training places - and a hint of more to come later this year - and an extension to the role of primary care trusts (PCTs) which will commission care on behalf of practices.
In a speech to the Royal College of General Practitioners (RCGP) in London, Mr Blair said he wanted to "stimulate innovation" and "tap the energy and creativity of GPs and spread best practice".
Those who agree to the targets will receive an immediate payment of £5,000 to help them provide improved services such as extended surgery opening hours, better care for coronary or cancer patients and training GP specialists.
This money will be doubled by the end of the year if they achieve these aims. GPs can take it as a cash sum for themselves, reward practice staff or put the money back into patient services.
A spokesman for the King's Fund said: "It looks as though the government is finally beginning to realise that primary care is where the real revolution in health care needs to happen. Targets for GP surgeries will put staff under even more pressure to perform, especially with the added incentive of a £5,000 'cash bonus'."
Mr Blair also announced an extra 550 GP training places and a further 400 GP trainers to improve recruitment in the profession.
The role of PCTs, which are responsible for commissioning local care services, will also be extended. By 2004, they will control at least 75% the NHS budget - compared to 15% in 1997.
Some £25m is to be set aside over three years to establish teaching PCTs - equivalent to teaching hospitals - in deprived and under-doctored areas. The first three will be launched on April 1 in Salford, Bradford and Sunderland.
GPs and nurses will also be given funding to improve their knowledge of cancer and provide better support for patients, while every GP will have his or her own desktop PC connected to NHSnet, the health service intranet, by the end of March 2002.
The prime minister announced the appointment of a national director for primary care services to oversee the reforms. He is prominent Labour-supporting GP Dr David Colin-Thome, who is currently director of primary care for the NHS London region.
The British Medical Association has complained GPs are now giving, on average, 10,000 consultations a year - 50% more than when the NHS was founded in 1948.
It has warned that government plans to appoint an additional 2,000 GPs in England by 2004, was still less than one-fifth of the 10,330 it believes is needed to provide a satisfactory service.
The government hopes to placate GPs by reducing the red tape in primary care. A report launched today states they will no longer have to sign pensioners' driving licence forms, passport applications and postal vote applications.
This should free up 750,000 working hours, which works out at one appointment a day for every family doctor in the country.
Dr John Chisholm, chairman of the BMA's general practitioners committee, said: "GPs are struggling to care for patients under an intolerable workload burden. Reducing bureaucracy will help. These are small but welcome first steps but more fundamental action is still needed to improve GPs' working lives and the quality of patient care."
The shadow health secretary, Dr Liam Fox, set out the Conservative's plans to boost general practice, including making all doctors work as a GP for six months after registration.
Liberal Democrat health spokesman Nick Harvey said: "It is absurd that the government is talking about cutting red tape for doctors and at the same time introducing more targets and paperwork."
