Margaret McCartney: For better primary care, pay GPs for service

How should GPs be paid: by item, or for service? Currently, it’s per item, through micromanagement. Not per appointment but by ticking boxes: smoking or not, cardiopulmonary resuscitation or not, blood pressure target or not.

But the box may not represent anything useful, appropriate, or kind. Say “every contact counts,” and repeat the mantra “GPs are ideally placed to . . .”—whether evidence based or not.

When GPs achieve many ticks, up the ante: make the hoops smaller and higher. Add items that have not been proved to cut unnecessary admissions or to reduce …