Christmas may seem like some far-flung memory, but over the last 6 months much has happened in general practice. While much of it might feel familiarly depressing, there are at least flickers of light for some at the end of the tunnel.

In December 2016 NHS England published the draft multispecialty provider contract. We examined what it means for general practice (essentially the fully integrated model means the end of independent general practice as we know it, but only if GPs choose it, which seems unlikely), and what it means for CCGs (another nail in their coffin).

One thing that didn’t change in the last six months was the money (or rather the lack of it). The contract for 2017/18 was finally agreed, but promised additional GPFV money was nowhere to be found. Indeed, despite our campaign to try and find it, no one was really sure where it was, until eventually the NHS England “Next Steps on the Five Year Forward View” document revealed there never really was an additional £2.4bn.

Despite the “highest ever number of GPs in training” (a ministerial phrase we are already growing heartily sick of), the total number of GPs continued to fall. GPs left faster than they were coming off the end of the burgeoning production line. Nick Mattick gave us an expert insight into GP recruitment, as well as a six stage guide for practices to follow, and Dr Mayur Vibhuti told us how he is developing a new generation of GPs.

For many practices, the challenge of recruiting a GP partner has been the biggest recruitment challenge of all. We tentatively suggested what a training programme for GPs considering partnership might look like, and are now working with Dr Mayur Vibhuti to see what we can put in place. Get in touch if you want to know more.

Not only is there a crisis in GP recruitment, there is also a crisis in GP nursing. Mia Skelly outlined the crisis and what needs to be done, and we found out detail from nurses in Lambeth about the tremendous work they are doing to support recruitment and retention of practice nurses.

It is not just nurses who can help GPs. Physician associates are just starting to be accepted as a possible support for practices – Dr Joanna Munden explained the impact they had had in her practice. Paramedic led visiting services may also be the future.

We also discovered the largely hidden work of Community Education Provider Networks (CEPNs) up and down the country, eloquently explained by Tara Humphrey. For those interested in developing the community workforce these are well worth looking into.

Glimmers of hope for the profession have started to emerge. The 10 high impact changes outlined in the GP Forward View are beginning to provide genuine benefit to some practices. In particular workflow optimisation (or GP post being managed by administration staff) is saving some GPs up to an hour a day, and active signposting is shifting up to 25% of patient appointments away from GPs in some practices.

Passionate advocates for general practice have become bolder and more vocal. Dr Jon Griffiths told us about his TedX talk promoting general practice, and Nish Manek inspired us with her passion for the profession.

Unlike MCPs, the “primary care home” movement has grown in popularity. GP of the year Dr Jonathan Cope explained how his practice now functions in what felt like a glimpse into the future of general practice. Adopted by Dr Cope’s practice, Beacon Medical Group, the shift to “hot” and “cold” sites is becoming increasingly common, and was explained to us by Dr Rachel Tyler from Ocean Health. We also had a live commentary from Dr Rebecca Pryse on what it feels like to be in a practice making such a change.

Getting bigger remains a key strategy for practices in trouble. A whole new lexicon of general practice organisations is emerging (do you know your super practice from your practice chain?).  Mergers expert Robert McCartney outlined the key to a successful union between two practices. The rise of the primary care home has led many to believe that reaching a population size of 30,000 is now a magic number for practices to aspire to, and Robert gave us his thoughts on how to get there.

The rays of hope are still, however, few and far between. The profession remains engulfed in crisis, while the government seems more concerned with extending access to GPs and putting GPs into A&E departments. If your practice has reached crisis point and you don’t know where to turn, have a look at our video, in which we examine the options open to GP practices and help you work through which one might be right for you. One thing continues to remain clear – the best hope for general practice remains the changes it can make for itself, not those it waits for others to make for it.