Jayne Dowle: Can GPs focus on caring for patients with one eye on balancing the books?

TWO things are certain about how the NHS reforms will affect us. We will all need to see a GP at some point in our lives, and we will all get older. Even my beloved aunty, who lived until her 80s and had not seen a doctor since the NHS was in its infancy, ended up at the local surgery in the end.

If we take notice of little else from the debate surrounding the new Health and Social Care Bill, published yesterday after a week of political argument, it is these two issues which matter to us all.

So we should think carefully about what we expect from our GPs. And consider seriously how we expect to be cared for – and how our care will be funded – in old age.

Under the reforms, GPs will be handed most of the 100bn health budget and given the right to buy-in services for patients, seeking out the most competitive deals between public providers and private companies on everything from cataract operations to bandages. The Primary Care Trusts and Strategic Health Authorities will be scrapped, and a new NHS commissioning board will oversee the process.

Personally, I can't really find much fault with the service my family has received from the NHS over the past decade. From childbirth and the excellent care given to my sister's premature baby, to emergency admissions, from major surgery for my parents and my husband, to getting appointments quickly at our local GP surgery, we have little to complain about.

I am quite happy with the way the NHS works for me, thank you. But many people would agree with the Government that cuts could be made. How these cuts will amount to between 15bn and 20bn in "efficiency savings" is a different matter. It makes me wonder, as a patient, how the NHS is supposed to cope, not only with undertaking this massive money-saving programme, but a total root-and-branch restructure at the same time.

And of course, in the middle of it all are us – the patients. I keep wondering if I have missed something. I had always assumed that GPs became GPs because they had a vocation – to deliver care to patients in the community.

Not one of my friends from university who trained as a GP did so because they secretly wanted to become an accountant.

Supporters of the reforms say in defence that more than 140 groups of MPs, covering more than half the population of England, have already volunteered to take part in the pilot scheme. The cynic in me can't help but think that they would anyway, because if they don't, they face getting left behind.

Already, it's that competition thing kicking in. And this is what worries me the most. What I want from my GP is someone who is knowledgeable, focused, and takes as much time as he or she can spare to understand the problem I have brought to the surgery. In fact, just like the GP at our group practice on Tuesday afternoon, when I turned up with my five-year-old daughter, ill for a week with a bad chest.

We phoned in the morning and had an appointment within hours. It wasn't flu, thank goodness, but he really took the time to examine her carefully. When his eye is forced to the bottom line instead, will he still have time to do this? Indeed, will he still have time to give us an appointment at all, or will we have to sit and worry with a sick child, ending up in an over-burdened A&E department because there is nowhere else to go?

Of course, GPs are only part of the plan. As well as everything else, the NHS reforms also promise to overhaul the care of the elderly in hospitals and care homes.

The headline idea is a pledge to improve the complaints system, and to introduce spot checks by senior nurses on geriatric wards to ensure patients are treated with dignity. Similar checks on care homes are promised. This is welcome. There have been some horrific cases of neglect involving older people.

And it's good PR, undoubtedly. But what the Government would rather keep quiet is how its cuts to local authority spending are already biting into respite care, affecting the hours that a carer can attend to help with basic tasks such as washing and dressing, and limiting free ambulance transport to and from hospital.

When we think about how we will pay for our care in old age, it's always the loss of our savings or the family home that bothers us. But the whole system is riven with loopholes and inequalities, as anyone who has ever had to find – and pay for – ongoing care for an elderly person will tell you.

If the Government can get to the bottom of this, and devise a fair and equitable system which supports those who need it, but does not discriminate against those who have accumulated even the most modest of assets, then it will help us all. And it might, just might, achieve something of more lasting benefit than the whole of the NHS reforms put together.