My plea for evidence-based management

This government is undeniably underhand. Nothing is ever done for the reasons given; hidden agendas are everywhere. The quality framework was originally introduced as 'entirely voluntary': now, low-scoring practices are threatened by their primary care organisations.

The Darzi clinics were ostensibly introduced to improve access, facilities and premises, yet many GPs believe their real purpose is to undermine traditional general practice.

Why does the present government hate GPs so much? Does it think we are expensive? Independent? Sub-standard? Awkward? If we aren't told then we can't have a proper debate.

My own suspicion is that the government simply cannot bear individuals (especially powerful, independent ones) being in control of anything.

But maybe I'm wrong. Perhaps the government is taking its lead from the DoH, which thinks GPs are incompetent, lazy and overpaid. If so, it needs to take into account Professor Barbara Starfield's research which demonstrates that primary care systems are vital to the delivery of cost-effective medical care. Or, more bluntly, whenever politicians ignore general practice, the NHS suffers.

Has the government thought through the ramifications of its real agenda for general practice? I suspect not. It isn't just primary care that is at stake. A staggering seventh of all undergraduate medical education now takes place in general practice. Will this teaching still be performed in the Darzi clinics, with protected time allocated to it? Will the salaried doctors in these clinics really have the motivation to attend the teacher-training seminars run by the medical schools? If not, where will this slice of undergraduate teaching take place?

The trouble with a hidden agenda is no one knows the real battlegrounds. If the DoH can provide comprehensive evidence that GPs are incompetent, let it do so. I don't believe it can, which is why it has to resort to innuendo. We need a frank debate.

Over the past few years we've heard a lot about evidence-based medicine. It is now time for everyone to insist upon open, evidence-based management.

Dr Lancelot is a GP from Lancashire. Email him at

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