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Views & Reviews No Holds Barred

How to undermine general practice

BMJ 2014; 348 doi: (Published 16 June 2014) Cite this as: BMJ 2014;348:g4061
  1. Margaret McCartney, general practitioner, Glasgow
  1. margaret{at}

The destabilisation of general practice is underway. Most general practices in England are not paid a regular amount but make their money through the contract negotiated in 2004. Core funding includes the “global sum,” which makes up about half of a practice’s income 1 and now amounts to £66.25 for each patient every year2—cheaper than the cost of health insurance for a pet dog.3

The rest of a practice’s income is earned in bits, bobs, and from ticking the boxes of the quality and outcomes framework. It was anticipated that the 2004 contract would leave some practices vastly worse off, and so the “minimum practice income …

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