Robbing Peter to save Paul

Our remuneration, in all its forms (enhanced services, core services, practice-based commissioning) is challenging the tempers of the GPs and PCT board members of our little bit of Suffolk. As one who keeps her ear to the ground, I am unsurprised at the tremors now issuing from the Asylum (as we affectionately call PCT House).

The only thing I find extraordinary is that our PCT ever imagined we would welcome its plan to save money by removing it directly from our pockets. Not since the townsfolk besieged the abbey in order to flatten the monks and acquire lots of very valuable beer for nothing has Bury St Edmunds witnessed such a blatant attempted cash grab.

Mind you, look what happened then. The great Abbey Gate, that sturdy stone hulk built to withstand invading Danes, crumbled to bits. All that remains now are some old bits of wall and a lot of symmetrical flowerbeds full of matching tulips.

I'd hate to see general practice go the same way - yet we risk a fate worse than tulips. Some of us are belligerent. We belligerently fail to see why, after signing our nationally agreed contract, we find ourselves involved in prolonged local negotiations over what we're to be paid for what we're already doing. You can knock me off my crutches with a pushchair if you like (why not? Everybody else does) but it seems simple enough.

You agree what you're to be paid, you shake hands, then you get on with it.

But others seem to feel helpless, and so we are, like the walls of Stalag Luft, undermined by tunnels. Bits of our job are put up for grabs. We're asked to tender for them but told how much they'd like us to bid - they asked us to bid a miserly £8 per patient for minor injuries, work that was priced at £50 in the GMS contract.

Amazingly, most local practices agreed on £8, stating there seemed no alternative, and the inmates - sorry, board members - at the PCT informed the rest that they didn't actually want bids from us that are different from everyone else's. They like their tulips matching, you see.

Fortunately, there are still those among us prepared to make a stand.

The PCT's rather petulant wailing that other practices have bid £8 so why can't we is falling on stony ground and we bid £21, which is what they paid us last year. There are, we remind them, still some bits of the wall of Bury St Edmund's famous Abbey still standing firm 1,000 years after the people of the town knocked the gate down. And we shall be too.

Can you hear digging?

- Dr Selby is a GP in Suffolk.

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