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How about an item of no-service fee?

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It’s a truism to say that, in GP land, you never get thanked for saying ‘no’. And, like most truisms, that’s because it’s true.

Take the recent hot air about a potential revamp of sickness certification. One of the issues is that GPs rarely argue the toss about signing a Med 3. Why would we, when a refusal to rubber stamp a few duvet days is typically met with a volley of abuse, an official complaint, or a misspelt declaration on NHS Choices that we are, quote, ‘The worst practise in the world’.

Ditto requests for antibiotics, X-rays, scans, referrals, etc etc. The only motive for putting up a fight is the desire to maintain some vestigial senses of pride and professionalism.  But they’re disappearing in inverse proportion to our medical defence fees.

So here’s a thought. Let’s reward saying ‘no’. Literally. Let’s actually provide GPs with a financial incentive to decline rather than incline, to turn down rather than cough up and to demur rather than refer. If the Government is genuinely keen on cutting indiscriminate prescribing, referrals to hospital, unnecessary investigations, soft sick notes and so on, it should put its money where its mouth is and make it worth our while.

Sure, there are already some incentives in the areas of prescribing and referral , but these are patchy, diluted out and don’t directly reward the GP. What we need is something tangible and meaningful. Something we can tick whenever we do it. Or rather, don’t. In other words, an ‘item of no service’ fee. Or a ditching of QOF for QOR, ‘Quantity of Refusal’.

It would be open to abuse of course, and it would require some monitoring, but what system isn’t and doesn’t? But it would, at last, be just reward for the few of us who are prepared to have blood spilled on the carpet, and don’t have the funds to get it cleaned up.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

This blog is part of our ‘Great GP Debate’ season. If you would like to write a blog on how you see the future of general practice, then please email the Editor at

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Readers' comments (6)

  • Dr 'no' also generally has a quieter easier life as the punters dont come back

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  • AlanAlmond

    If you say no often enough people stop coming to see you and book to see the guy who'll say yes instead not to be the yes guy in a practice of'll soon get swamped, a particular risk for the recently qualified GP eager to make folk happy.

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  • AH! - but in a practice which evens out workload, yes-ers get returning trivia and the no-ers have to deal with more truely ill patients.

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  • am Dr No Monday am but Friday pm Dr Whatever gets me out of here. Wednesday between the two.

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  • Fantastic idea! I would be driving a Bentley if this had been in place for the last 25 years - instead I have become an expert at writing complaint response letters.

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  • Listen here doc, 'I know my rights'
    Or 'but that's not fair, my family don't fink I'm fit to work' . My response was, 'in my clinical judgement.....' Was met with a ' wassat thT mean then?' . Nuff said

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder