Dr Phil Hammond, GP and broadcaster

As a gauge of just how ïpatient centredÍ our fabulous New Labour NHS has become, IÍve been asking audiences on my tour what they want from the health service. And guess what? Not one person has said ñMore targets please, Mr Milburnî.

There are more than 400 of the blighters in the NHS Plan (I counted up to 398 before nodding off), and despite calls from the medical establishment to ease off and promises from central Government to stop the checklist medicine mentality, the proposed new GP contract appears riddled with them.

Now, IÍm not against targets per se, and a few well chosen and universally agreed (rather than imposed) ones might be a good thing. But thereÍs a tendency to confuse targets with standards, when in fact too many of the former stuff up the latter.

WeÍre back to the old quantity versus quality debate. Is it better to see all patients within 48 hours for 30 seconds at a time, or would a 15 minute consultation within a week be much more useful? The NHS is like a tube of toothpaste, and setting too many standards means squeezing lots of bits at the same time, rather than a coordinated surge forwards.

IÍm not a betting man but IÍd stake my mortgage on the fact that if every GP hits all the new quality targets, you wonÍt all get the promised windfall. The history of performance-related pay in cash-strapped organisations is that the bonuses depend on whether the money is actually there at the end of the year.

And with most primary care trusts starting life heavily in debt and saddled with prohibitively expensive PFI contracts for the next 20 years or so, the chances of you all getting the pay you deserve are fairly remote.

Alas, if you take the ethical ïanti-targetÍ stance and do nothing, youÍll not only be unpopular with the Government, but your income will actually fall. So voting yes will condemn us all to a life of frenzied hoop-jumping. But in our politicised NHS, diseases donÍt have an equal footing and thereÍs bound to be a tendency to concentrate on those that garner the most brownie points.

John Seddon, an occupational psychologist and management consultant, thinks we should do away with the target culture altogether. He told the Public Administration Select Committee that targets are ñinherently flawedî and ñactually undermine achievement of purpose, which is improving public sector performanceî.

Instead, we should concentrate on improving our capability and competence, allowing front-line workers to be creative and think for themselves, rather than blindly following central diktats like lemmings. This way to the cliff...

ThereÍs an old saying that research and reform rarely go arm in arm. I can understand the political imperative of having something measurable to try to prove that the vast expenditure on the NHS is worth it. But the evidence that more targets will provide value for money is lacking.

WhatÍs needed is less politicisation, not more. Kick out the Ministers, ditch the Department of Health and free the NHS to negotiate its own way forward and serve local populations.

  • Dr Phil is back on tour with 89 Minutes to Save the NHS. Details at www.karushi.com

Guidelines in Practice, April 2003, Volume 6(4)
© 2003 MGP Ltd
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