Lack of trust

There is a lot of anger displayed in UK medical blogs at present. I'm not entirely sanguine about things myself, although I prefer to express myself in moderate tones. We are now approaching the end of the financial year, and Myrtle (our practice manager) tells me that we should score about 960 of the 1,000 possible QOF points.

We both think it is outrageous that no pay increase has been given to GPs this year. Our income consists of the global sum which covers the basic costs of running the practice, the QOF payment which is an agreed target-based reward for demonstrating good care in many areas, and payments for various optional "enhanced services" which practices can offer if they wish to do so. If the Government didn't expect GPs to score highly on the QOF, then they were badly advised. We were given targets to reach, and we reached them. What they are effectively saying is that because we achieved more with QOF than they thought we would, we have "earned too much" and so they will not increase the global sum which, it was agreed, should cover basic costs. Those costs have of course risen, so our profits go down. But the new contract was intended as a complete break from the past. Previously the contract was with individual GPs, and there was an "intended average income" for each GP. Under the new dispensation the contract is with the practice, and payments are made for providing services and achieving targets. The income of the people working within the practice is irrelevant.

Behind their mealy-mouthed explanations, the Government are clearly going back on the agreement they made with us three years ago. This will cause GPs a great loss of confidence in their bona fides, as they have shown that they are untrustworthy. Although some GPs are angry that the GPC have not proposed a ballot on "industrial action", I think that what they are suggesting is correct. From now on we should see everything from a strictly business viewpoint. In the past we have co-operated with the Government's schemes, because it seemed to be in the interests of the NHS as a whole. From now on we should only do those things which are profitable for us.