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Inner-city GPs must beware

From Dr John Eggleton, Exeter, Devon

It was with great sympathy that I read the article by inner-city GP Dr Anthony Lister (Opinion, 12 April). 'The GPC is fiddling while inner cities burn,' he said, and also that he 'has enough to cope with without the added kick in the teeth of the square root formula for adjusting QOF payments'.

I used to work as a singlehanded inner-city GP and I would draw the attention of your readers to a letter of mine published in the BJGP as long ago as September 2002 (p766).In it, I said: 'The sad fact is that where GPs take on 'more difficult patients', where hospitals take on 'more challenging surgery', where the police try law enforcement in 'more lawless areas', where teachers try to teach 'more difficult children', in fact where anyone tries to do something that is more difficult in a way that cannot be measured, that person is doomed to being marked down by those who judge performance.'I went on to coin the tongue-in-cheek expression 'Eggleton's Law of Inverse Credit'.At that time I was concerned about an article in that journal by Professor David Mant, in which he called for the then newly-created PCTs to take on the 'unprecedented opportunity for dealing with the issue of poor-quality care'. I warned of the problem of defining poor-quality care, when one has to take into account the crucial, and often very negative, role which people living in deprived circumstances in our inner cities often play in their own healthcare.My letter was ignored by the RCGP and by those involved in the introduction of the new contract, even though I specifically warned even then that the contract proposals would make matters worse.What happened next? Even with a maximum possible point score on the QOF my little surgery became financially non-viable and I was forced to close it. The same fate applied at the same time to another singlehanded GP in Exeter and all our former patients now attend large health centres, which this Government sees as more cost-effective. Dr Lister beware!

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