The system of remuneration of GPs is at face intended to provide a
suitable income to an average GP doing an average job.
It fails.
Moreover, systems with a possibility of tackling the other elements
which have been loaded into the remuneration system have been
introduced or are about to be introduced by the Government, such as
Clinical Governance, the formation of GPs into collectives as PCGs.
Much of the wasted effort in Health Authorities and in practices is
wasted by the administrivia of claiming many small fees, and by
competing to little effect on GP income, and none or a negative
effect on patient welfare.
One of the more glaring adverse effects is that the payment systems
unfairly penalise GPs in Scotland, who are not notably less
hard-working or effective than those of us in England.
Much variation between incomes of GPs in England is produced by
events wholly or partly outside their control, and little reflects
the outcomes of treatment.
The payment system should be drastically simplified, and as a
starting point, I suggest the idea of giving each GP the net
intended annual remuneration, removing all item of service payments,
and then applying guidelines of good practice via a clinical
governance framework to identify where work which should be done is
not being. I believe the money and time saved would be sufficient
to run the clinical governance system, provide many of the missing
resources that are the key determinants in whether good practice can
be applied, and still leave enough over to spread equitably among
GPs as an increase in "salary".
--- OffRoad 1.9r registered to Adrian Midgley
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