Trust wants help in formulating system to recognise performance of salaried GPs
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7209.574 (Published 28 August 1999) Cite this as: BMJ 1999;319:574
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dear Editor,
Irvine et al. ask for help in formulating a merit
award system for general practitioners. Ignoring the dislike that most
general practitioners have of such a system, They suggest using membership
of the General Practice Committee, National Institute for Clinical
Excellence or taking a leading role in The Royal College of General
Practitioners as markers of good practice.
I worry about general practitioners, when they prefer to spend significant
time in London doing 'important things' rather than seeing patients. Do
they enjoy the process of consulting? Membership of one of these
committees may suggest that the person does not actually like doing
general practice. Membership, then, may be a factor militating against
someone getting a merit award.
Merit awards, if they are needed, should in my view be based upon good
medical practice. Perhaps an enhanced version of the examination for The
Royal College of General Practitioners would be appropriate.
Consideration should also be given as to whether a merit award should be
for life. Ought it only be for as long as meritorious service is provided
to patients ?
Andrew Sanderson
General practitioner
14 St. Mary's Grove, Tudhoe Village, Spennymoor, County Durham DL16 6LR
Conflicts of interest - none
Funding - none
Irvine S., Joyce L., Barnes M. - Letter BMJ 1999;319:574
Competing interests: No competing interests
Sir,
Irvine, Joyce and Barnes are to be congratulated in their request for
help in formulating a system to recognize the performance of salaried
GPs. Few would argue with their wish list of criteria yet these do not
appear to address the quality of work as a GP.
I am a Clinical Governance Specialist for East Devon PCG, GP Tutor at
our postgraduate centre, Audit Co-ordinator for East Devon.... I could go on
but believe that none of these posts make me a better GP. I suggest that
the most important criterion might be that the GP concerned can
demonstrate that (s)he has developed and runs continuously a system of
monitoring his or her own performance which assesses patient satisfaction
and outcomes. Another is a commitment to offer evidence based best
practice with a method of continuous improvement. If the GP can
demonstrate both of these then let him or her become a national figure,
edit a major journal or become a member of NICE but let's get the cake
right before the icing.
Phil Taylor
Competing interests: No competing interests
Response
Dear Editor
I have just read with interest the letter from Sally Irvine et al.
[28th August] asking for help in formulating a system to recognise higher
than standard performance by salaried General Practitioners. They are to
be congratulated in taking this initiative.
Fellowship of the RCGP by assessment is clearly essential as a
starting point for higher, or merit award, recognition. Contributions to
teaching, research and publications are important as is recognition of
giving time and expertise to management taking senior roles in the RWP,
BMA etc. But no mention is made of the doctor who provides that extra
commitment to the care of her/his patients and leadership of the team that
cares for them. These aspects will be covered partially by the Fellowship
by assessment but there is an opportunity to further recognise those GPs
who can and do take them to a higher level of achievement. After all the
care of our individual patients is the most important part of a GPs work.
Throughout the Health Service higher financial rewards are obtained
by being removed from the direct care of patients. This is right and
necessary but few incentives remain for those whose inclinations and
talents lead them to devote most of their time to direct patient care.
Here is an opportunity to correct this for at least some of the proposed
awards, which will presumably be very limited in number.
Information gathering and fair assessment will not be easy but some
areas for consideration could be:
1 A substantial proportion of the working week spent on direct
patient care by consultations in surgery, on home or Community Hospital
visits and in correspondence etc. associated with those individuals. [say
75%-80%].
2 Effectiveness as leader of the primary care team --- as judged by team
members and those who have dealings with them.
3 Opinions of other professionals such as neighbouring colleagues in
general and hospital practice.
4 Effectiveness in initiating, implementing and assessing innovations in
practice.
5 Opinions from as wide a range as possible of patients on the treatment,
care and empathy provided for them.
The NHS is not good at rewarding those who work hard and effectively in
the 'front line' for most or all of their careers. Here is an opportunity
to change that in one place, which could then be extended to others, eg
the nurse who works with an above average commitment for her patients
rather than going into management. You never know, it might improve morale
and encourage people to stay in the NHS.
Dr P G Kay
Competing interests: No competing interests