BMJ  2005;331:965 (22 October), doi:10.1136/bmj.331.7522.965-a

Letter

Do GPs deserve their pay rise?

Of course successful hard work deserves reward

EDITOR—Timmins' article on general practitioners' recent pay rise voiced the common view that if targets are exceeded then they were undoubtedly too easy.¹

Since 1997 funding for the hospital sector has grown quickly, with general practice funding becoming a successively smaller proportion of NHS spending. During this time, hospitals have been adept at transferring responsibility for chronic disease management and follow-ups to general practice, with no corresponding transfer of funding. Now, when general practice has the opportunity to receive funding for this work, under a far more stringent and detailed performance management framework than has ever been accepted elsewhere in the NHS, the idea that success in this framework might be due to good organisation, teamwork, and hard work is simply not considered.

A further misconception is that the relation between this funding for additional work and pay rises for general practitioners is simple. Practices have invested (often heavily) in additional staff in the knowledge that funding would only be forthcoming if the targets were reached. This degree of personal business risk taking is almost unknown elsewhere in the NHS, or in the workplaces of the health economists quoted.

The idea of giving groups of clinicians extensive control over budgets and teamworking, carrying personal financial risk but also the possibility of reward for success, is not new or unique to British general practice. It lies behind the success of the Kaiser Permanente health maintainance organisation in the US. Many NHS managers visited California to see Kaiser Permanente, but few if any subsequently seem to have recognised or valued the same features in British general practice.

So, why not be a bit more upbeat about how well at least one part of the NHS can perform in a framework of 146 separate targets, if allowed modest but adequate funding support?

Munro Medical Centre, West Elloe Avenue, Spalding, Lincolnshire PE11 2BY w1{at}mac.com

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Competing interests: None declared.

References

1. Timmins N. Do GPs deserve their recent pay rise? BMJ 2005;331: 800. (8 October.)[Free Full Text]

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Relevant Article

Do GPs deserve their recent pay rise?

Nicholas Timmins
BMJ 2005 331: 800. [Extract] [Full Text] [PDF]