This time it is the latest round of the government-backed crackdown on PMS. Some PCTs want to 'move towards a more even distribution of pound-per-patient ratios'. This translates as PCTs thinking some PMS practices receive too much funding and their approach to tackling this is to suggest cutting it to the PCT average.
It isn't really an argument about fair funding but a method to cut primary care spending.
There is, of course, no indication that PCTs are comparing like with like.
Imagine doing your grocery shopping that way. Try telling Tesco that nectarines should come down in price because their pounds-per-fruit ratio was much higher than the average for apples and pears regardless of source, quality or availability.
Working on bald averages for GP practices is equally foolhardy. Will the PCTs take into account the variety of factors that can affect practice income? For a start there are the averages the PCTs quote based on adjusted or non-adjusted patient numbers? PMS practices may have higher mortality and morbidity rates, for example, due to the particular population they serve.
Then there is the question of specialist or additional services. PMS practices have often had additional work such as running specialist clinics or services written into their contracts. To compare like with like these services must be valued.
And then there is quality - will the PCT reviews include quality or make any objective judgement on the services on offer. After all, we are more likely to pay more for large shiny, juicy apples than some wrinkled little windfalls.
It may be that following such an assessment that some PMS practices would be found to be overpaid per patient but at least there would be an objective measure rather than this 'law of averages'.
Certainly reducing PMS partners' income to pre-new-GMS levels, as accountants warn could happen in some practices, is not the best way to ensure quality service.
Indeed, if PMS partners can earn the same as salaried GPs without the hassle of running a practice, will some of these practices remain open for very long? What then for the patients who should be central to this review? Is no GP service really value for money?
Of course it is the role of PCTs to ensure cost-effective delivery of high-quality healthcare, but that role requires sophisticated analysis not back-of-the-fag-packet sums. Otherwise health consumers could be left without even the fruit shop.