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At the heart of general practice since 1960

GPs think it's a waste of time to report violence

They say life imitates art. In a wonderfully inventive short story by Kurt Vonnegut there was a character called Diana Moonglampers, a rampantly authoritarian figure whose mission in life was to neutralise outstanding talents and ability in order that there would be no possibility whatsoever of inequality of opportunity.

In sporting events gifted high-jumpers were required to perform with lead weights round their legs; students with exceptional mathematical ability were required to perform their examinations wearing earphones that poured out white noise and a babble of random numbers.

I am reminded of this every time I read that GPs have 'overperformed' on nGMS. The very use of the term 'overperformed' sounds churlish and pejorative. Is it because the bar was set too low, or because in order to galvanise GPs it is necessary to stroke their wallets? I don't think so.

It is because our response has cost more than anticipated. Many GPs have been performing to these standards for years, but too often the data was not entered on their information systems in a form that could be easily accessed, accurately searched and translated into performance-related Brownie points.

The positive side of nGMS is that, through their Herculean efforts and inate adaptability, many GPs have made a great leap forward in the management of information.

The hidden cost may have been that a shift of emphasis in the consultation has subtly (and by some accounts not so subtly) changed: listening, continuity of care, and finding out the reason for the patient's attendance, which are not measurable skills and do not attract a QOF, have been subsumed by a doctor-centred approach directed towards items that attract a QOF payment.

The response from our paymasters almost certainly will be to shackle us with the contractual equivalent of adding lead weights and white noise while raising the bar, irrespective of resource and outcome considerations.

By unilaterally imposing new targets, they will ensure most GPs will find them unachievable.

Diana Moonglampers rides again.

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