Why ministers want to bankrupt practices

I'm convinced that the government intends to destabilise general practice in order to reform it cheaply. The principles of the plan are: persuade the public that GPs are selfish and overpaid; create a network of Darzi and APMS surgeries offering extended opening; then suddenly withdraw MPIG to destabilise existing surgeries.

Under financial stress and unable to provide the workforce to match the new surgeries' opening hours, many existing surgeries will close as their patients transfer their allegiance. A new era of primary care will dawn with cheap, salaried GPs doing shift work in high-quality premises.

The problem fighting this plan is that the end result is superficially good. Certainly it allows the government to improve premises and increase access to primary care - but in an underhand way, and on the cheap. Doing it the honourable way - nationalising existing GP practices by buying them up - would cost a small fortune. So why not eliminate the need for this expenditure by bankrupting them? The responsibility for the current problems of availability and premises' underfunding lies squarely with governments of all hues over the past 40 years. The piecemeal approach to primary care funding - finance for this, support for that, only to find that money isn't available because the PCO has run out - is exactly the wrong way to do it. What we need is a truly global sum, centrally resourced, that includes everything, especially premises - a formula that, unlike Carr-Hill, is properly funded and takes into account the cost of wages and property in cities. Then make the same formula apply to all practices, whether GMS, PMS or APMS. Now everyone operates on a level playing field, and there will be no discrimination against existing practices.

Just because the government's suspected Machiavellian plan deals successfully with access problems and premises doesn't mean that it is right, proper, moral, fair or appropriate. Super-surgeries staffed on a rota basis will undoubtedly reduce the quality of the continuing GP-patient relationship.

Nor is it right for the government to destabilise practices by providing unfair competition. The government came to power promising an ethical foreign policy: it needs an ethical domestic policy, too.

Dr Lancelot is a GP from Lancashire. Email him at GPcolumnists@haymarket.com

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