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Views And Reviews Acute Perspective

David Oliver: Making less popular medical jobs more attractive

BMJ 2018; 362 doi: (Published 10 July 2018) Cite this as: BMJ 2018;362:k2936

Re: David Oliver: Making less popular medical jobs more attractive

As always, Dr Oliver's observations make a great deal of sense, at least from the perspective of a layman who has worked with and around doctors for 50 years. He touches on primary care. As with the proposed contract reforms and the partnership review, he does not mention the mechanism that once existed for the equitable distribution of GPs throughout the country.

The Medical Practices Committee for England and Wales, which was first emasculated then abolished in 2000, had a discretionary power to refuse qualified GPs to put up their plate in areas the MPC considered were already adequately or over doctored. The idea was that GPs would instead choose to work in under doctored - usually deprived - areas. Over the years, and especially in periods of GP shortages, the controls worked well, to the extent that there were no severely under-doctored areas by 1986. The MPC also had power to create vacancies eg in areas with rapidly expanding populations, and there were financial incentives for these areas as well as those that were severely under-doctored. Criticised for being either too lenient or too harsh in allowing/ refusing GPs to join existing practices, the MPC was never popular. But no replacement system has ever been suggested, and areas with deprivation are getting increasingly under-doctored as a result.

I was Secretary of the MPC from 1981 to 1983 and again from 1995 to 1999, but I don't regard that as being a competing interest now.

Competing interests: No competing interests

11 July 2018
john gooderham
locum lollipop lady