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At the heart of general practice since 1960

Contract is memorial service for our once-noble vocation

In your story 'GPs face a postcode pay lottery' (July 14) you quote Geoff Minns, chief executive from my SHA, Cumbria and Lancashire, who quite rightly points out the complete 'Horlicks' that the Government has put PCTs in.

The director of finance of our PCT is trying to establish with the SHA where the alleged finance is. Irrespective of this, however, the outlook for enhanced services is bleak.

I have done some work on enhanced services for the LMC. I have looked at the financial implications for my practice of 10,000 patients in a mixed urban/rural setting providing the following enhanced services: childhood imms/vaccs, flu vaccs, minor surgery, IUCDs, enhanced services for patients with MS and depression and monitoring anticoagulants and DMARDs.

The potential income is £90,000, but note that this is mainly work we are already doing and are already staffed for.

If we are denied this income this could significantly destabilise practices.

On my calculations, for this fairly limited list of enhanced services, the cost for my PCT would be £2.7 million. The Government has allocated £2.2 million.

My presumption is that PCTs will be reduced to 'pile 'em high, sell 'em cheap' solutions, involving NHS Direct nurses and the odd salaried GP, with patients herded into polyclinics blistered on to hospitals.

I have read in detail the NHS Confederation brief to PCTs on the contract and I note £8.1 billion is promised to primary care.

This briefing, and GPs' own experience, confirms my fears that PCOs will in fact radically redesign services and that money to 'primary care' will not mean money to general practice if the service can be provided cheaper elsewhere.

This will result in the salami slicing of general practice until there is no viable core.

What the GPC has signed is not the renaissance of independent general practice but an order for the memorial service for a once-noble vocation.

From Dr Robin Jackson, Lancaster

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