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At the heart of general practice since 1960

I'm outraged at defence of square root

I read Dr Adam Pringle's attempted defence of the invidious square root formula with increasing incredulity and outrage.

The main plank of his argument seems to be that scrapping the formula is 'just another bit of largely pointless fiddling'.

By contrast, introducing the square root formula in the first place was fiddling around for a purpose. It was a highly ingenious method of taking money from doctors who had high prevalence of chronic disease and needed the money to do the work, and giving it to doctors with low prevalence who had quite obviously not done the work.

Dr Pringle claims people far cleverer than he is have demonstrated that square rooting saves the Government money and that in abolishing it they will save more. Hiding behind these clever people presumably absolves him of the need to produce any sort of reasoned argument.

There is nothing implicit in either the application of the square root formula or its abolition that would suggest it is anything other than revenue neutral. The only way the Government would save money would be if doctors with high prevalence did not go the extra mile in diagnosing and treating that one extra case of diabetes because of its diminishing return to the practice.

Is this what Dr Pringle wants? It would appear so, because he goes on to argue that removing the formula would bring about 'rapid rises in prevalence'. In Dr Pringle's world, doctors in deprived areas are not to be trusted.

Astonishingly, Dr Pringle goes on to argue for flat-rate capitation. This is the very system that caused general practice to stagnate in the 1960s and 70s. In our practice in an extremely deprived area we have just finished interviewing for a partner and for the first time ever have had interest from a large number of excellent candidates. I have no doubt the new-found commitment to fairness by the Government, signified by the dumping of the square root formula, contributed to the improvement.

Dr Alan Keith, Rotherham, South Yorkshire

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