Intended for healthcare professionals

Rapid response to:

Clinical Review

Mumps and the UK epidemic 2005

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7500.1132 (Published 12 May 2005) Cite this as: BMJ 2005;330:1132

Rapid Response:

Mumps dissent

I would like to comment on just one aspect of Magda Taylor’s
excellent response to Messrs Midgley, Johnston and Lewis. (21 May 2005)

She mentioned the target system for the remuneration of GPs
conducting childhood immunisation. Targets for vaccination and cervical
cytology were introduced in 1991 as part of Mrs Thatcher’s health service
reforms. They have been highly successful at raising the level of
immunisation uptake. Kenneth Clarke, the then Health Secretary (and now
possible Tory Party leadership hopeful) was very perceptive about what
motivated doctors. The financial penalty for not reaching the higher
target level is considerable. The advice a person gets about whether to
have a smear or to have their children immunised has little to do with
confidence in the cervical screening or child immunisation programs. It’s
all about practice income and maximising it – pure and simple.

The introduction of the new ‘five-in-one vaccine and the generally
lower uptake of MMR will bring new financial anguish to GPs as practices
struggle to reach the 90% uptake target. Just one or two conscientious
objectors amongst parents will result in a loss of £5,700 in target income
for the average practice (Pulse 30 April 2005, front page) It is no wonder
that some GPs are tempted to remove these dissenters from their lists.
Recognising the danger, the GP negotiators are now forlornly fighting the
Department of Health for ‘informed dissent’ for childhood immunisation, to
soften the blow of these target remuneration changes.

However, the bottom-line to all this is this: the GP is not a source
of impartial advice on the safety or otherwise of vaccination. The parent
who wants to be reliably informed should beware and look elsewhere.

Competing interests:
a GP principal for 15 long years, now salaried and somewhat less conflicted by financial interest in vaccine uptake.

Competing interests: No competing interests

23 May 2005
Mark Struthers
General Practitioner
Bedfordshire mark.struthers@which.net