Letters, calls and emails: The extreme disease prevalences responsible for skewing weighting of quality pay appear to come largely from organisations that are not traditional GP practices.

Dear Editor

Dr James Hill raises a number of interesting points in his letter relating to the societal and political role of doctors  (GP, 22 September).  

‘Collusion’ is a dirty word, but in a sense doctors have been colluding with the government since the inception of the NHS.  

On the other hand, GPs have managed the extraordinary balancing act, until very recently, of being monopolist, independent contractors for the DoH, yet thumbing their collective nose at policies that they did not like, in the interests of their patients.  

I contend that nothing has really changed in this regard. True, our mouths have been ‘stuffed with gold’ again by the quality framework, but it really will not do for GPs to take their 30 per cent rise in profits and complain that the quality framework detracts from proper patient care.  

We can hardly complain about politicians’ one aim in life being ‘the acquisition…of power’. At least in our country this power derives from a popular mandate.  

At the moment, our politicians feel that this mandate will follow from improving access to health care in ways that I too am uncomfortable about. It is however my belief that politicians are following, not leading in this regard. It is the electorate that feels that ‘perfect health is achievable and illness defeatable’.  

I do not know why Dr Hill thinks that we have lost self-respect in implementing these policies, unless he implies that he and others are indeed taking the government’s shilling and compromising their personal and professional integrity.  

I contend that the increasing demand for alternative solutions derives not from the desire of patients to see a practitioner who ‘speaks to their patients’. It stems from their desire for a quick fix for common, self-limiting conditions. GPs, in attempting to be honest with their patients, do indeed try to ‘support ill health as a part of normal life’ but that is not good enough for patients any more.  

Again, the public is leading the societal change in attitude, and we must either learn to live with it, emigrate or retire.  

Like all golden ages, Dr Hill’s nostalgic view of the doctor–patient relationship of the 1970s seems an illusion. Does he really hanker for the days when a doctor would ‘mutter something that sounded professional’ rather than actually engage his patient? That sounds like a parody of a dysfunctional consultation.   

Dr Hill’s tirade against evidence-based medicine seems misplaced. Presumably, when his turn comes, he will want a coronary stent that has a proven track record of success.  

It also seems odd to say ‘woe betide the GP caught acting outwith the guidelines’. I certainly don’t, for instance, treat my 90-year-olds in the nursing home with a statin, and I would be very surprised if all my colleagues did.  

Dr Jeremy Platt  

Binfield, Bracknell 

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