Dr Ted Willis: Should we be paranoid, or infuriated?

There are two competing explanations for why so much work and criticism is dumped on we 'silent workers of the ranks', as Sir William Osler referred to GPs in his day.

Much of the time, it seems that the obvious reason for the development of bizarre QOF hoops through which we have to to jump, or absurdly unfair articles in the press about GP pay, is that some people really do have an axe to grind, and they are out to get us.

Typical suspects include politicians (and their cronies) trying to open up the NHS to competition from for-profit business, but the culprits can also include the media, the pharmaceutical industry and NHS bureaucrats.

One can apply the 'cui bono' test to pinpoint the guilty party among those who would benefit from any particular new imposition, and it commonly points to a likely suspect. This is known as the 'conspiracy theory' and it does have a lot going for it. However, there are examples where it seems to be very difficult to spot anyone who benefits.

Not long ago, the NHS prescription charge was raised from £7.85 to £8.05. This means that in pharmacies and dispensing doctors' surgeries all over England, staff are now counting out £1.85 in change over and over again; this involves a minimum of five coins, all of them different.

These people, particularly in small dispensaries, will regularly run out of coins and will have to go their local bank to get more, if they are lucky enough to have a branch nearby.

If they can, staff will encourage punters to claim exemption. So they will have more work to do than if the charge was £8, but due to increased exemptions, the money raised is likely to be less than previously, meaning nobody benefits.

For this, it seems another theory is needed - commonly known as the 'cock-up theory' (perfectly illustrated by the Health and Social Care Act, if you need an example).

The most elegant expression of this is known as Hanlon's Razor, an adage stating: 'Never attribute to malice that which is adequately explained by stupidity.' But hang on, what is £8.05 in euros?

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