There has been good and bad news across the NHS in Britain.

First, the bad. Commentators believe the long-predicted crisis for UK general practice is upon us. In my area of Forth Valley there are three practices that have been taken over by the health board because of an inability to recruit doctors; at the same time, governments in the four home nations promote what they are pleased to call "seven-day working"; finally, we have a minority of my professional colleagues calling for a salaried GP service.

It takes five years to train a GP but there is already a 20 per cent vacancy rate amongst new trainees and 30 per cent of those trained are contemplating emigration. One third of existing GPs are likely to retire within the next five years. The dire problems of replacing doctors in the remote and rural areas of Scotland have become evident in the heavily populated Central Belt and, despite this, and the fact that there has always been a 24 hours a day, seven days a week service for emergencies and urgent cases, we have the electorally popular promise of spreading the available jam over seven rather than five days a week.

To cap it all, some doctors propose a salaried service, not really to improve matters for patients but to seek protections over sickness, holidays and hours of work that employment law would provide.

How can it be that the discipline of general practice I entered 41 years ago has come to this? In 1974 when I arrived in Balfron, doctor morale was high. I look back with nostalgia to the GP Charter of 1966 constructed in a similar atmosphere of crisis by the-then Health Secretary, Kenneth Robinson. Overnight his GP contract had changed general practice from a disregarded backwater of the NHS into a properly funded enterprise with funding for new premises, sufficient support staff and strategies to stem the mass exodus of UK doctors abroad, mainly to Canada and the United States.

Nearly 50 years on, the same litany of bad and even worse news means that similar drastic action is needed. There is, however, good news but it is limited.

First and foremost, managers and politicians have finally recognised the irreconcilable dynamic of exponentially rising demand, limitation of both financial and human resource and the demographic time bomb of an ageing population for which medical and pharmacological technology can do so much more. The system is broken and only by understanding this can they, and we as a society, begin to fix it.

A salaried service will not fix it. The independent contractor status of GPs is good for the sanity of doctors. It's easier to face local problems with local leadership and solutions. But independent GPs are also good for patients who look to their doctor to be their advocate in an NHS of byzantine complexity and to provide continuity of care in the face of super-specialism in other parts of the service. So, it's good news that there is a commitment to adapt and improve the GP contract that could allow the NHS to begin again to value its highly skilled workforce.

General practice in all parts of the UK has rightly been described as the "risk sink of the NHS". Thankfully, politicians have begun to acknowledge the fundamental economic imperative: compromise the funding and support for general practice and the whole NHS edifice will collapse. Only now, with a late acceptance of that truth, can we recognise the good news that the status quo is untenable, and that change is essential.

Fortunately the NHS in Scotland is smaller, fleeter of foot and its managers and clinicians talk to, rather than shout at, one another.

The irony of the present situation is that we have seen it all before in the 1960s. UK general practice is recognised the world over as the most cost effective, responsive and personal service possible, where its doctors have the enormous privilege of providing continuous care to a defined population of individuals and families. Scottish doctors have always been in the vanguard of development and innovation.

While the Scottish Government and health boards have recognised the increasingly bad news, they have the opportunity and responsibility urgently to build upon the good - before it is too late.