Dr Phil Hammond, broadcaster and GP returner in Bristol

So, how have you been celebrating the first anniversary of the new contract? With a street party? A new car? Or maybe just enjoying those free Saturday morning moments with the family, rather than with a leg ulcer?

Most GPs I’ve spoken to have been better off financially since April 2004, but there’s a creeping suspicion that we’ve been bought.

Think back to your vocational training scheme interview, and I bet you didn’t say you were going into general practice “to implement a population based disease management programme”.

But that’s what we’ve signed up for and it’s taken all the fun out of consulting.

True, general practice should be about serving patients rather than just entertaining ourselves with a bit of therapeutic gossip. But I’ll be amazed if this tick-box approach makes enough of our patients healthier or happier to justify the huge expense.

Alas, we don’t have many good measures of health, and very few clinical trials even bother to measure the impact of a treatment on a patient’s quality of life, so we’ll probably never know if these reforms are a success or not.

All we have is absurd short-termist targets that politicians can wave around as evidence that the nation’s health is improving.

The previous Health Secretary, John Reid, and Alan Milburn before him, were convinced that the new contract would offer demonstrable benefits to all stakeholders – but where’s the proof?

Primary care staff can be paid to record the smoking status of their patients and for giving them advice on how to stop, but how many patients are likely to stop smoking in the long term?

To help get a star from the Healthcare Commission, the PCT has to record only those patients who claim they’ve given up for just 4 weeks – and we all know how many relapse after that time.

But who cares about patients when the doctors are richer, the PCT managers have a star and the politicians can claim success? And of course, the majority of smokers who start again after 4 weeks can be counted again next year for more money and more stars.

Some patients have undoubtedly been helped, but just as many complain that they are being treated by protocol rather than as a person, and that the system is inflexible.

Smoking clinics can have long waiting lists – hardly the encouragement you need to give up – and can be particularly harsh on patients who miss an appointment.

So we may not actually be helping the patients for whom we are chasing targets, and we run the risk of ignoring those with illnesses that don’t attract a financial gain.

Perhaps I’m being unduly cynical, but aside from the freedom of not being on call, and the extra cash, has the new contract given you more job satisfaction and made you happier?

Or, to put it another way, without the inducement of more money and nights off, would you ever have embarked on such a mechanistic style of practice? Please tick the box below.

Guidelines in Practice, May 2005, Volume 8(5)
© 2005 MGP Ltd
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