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No place for cash prizes for patients

Health secretary Alan Johnson is not a man for studied understatement.

Health secretary Alan Johnson is not a man for studied understatement.

He led the build-up to Lord Darzi's Next Stage Review by describing it as ‘the most important development in the history of the NHS'.

With a billing like that, the review could hardly fail to disappoint.

In truth, it is a mixed bag, with some good stuff about NICE and clinical leadership, some bad stuff about polyclinics – but not as much as feared – and plenty of the usual obsession with competition and patient choice.

And then there was the widely anticipated scrapping of the MPIG, which will bring many GPs out in a cold sweat, but is already the subject of negotiations with the GPC.

Perhaps, though, the Government was disappointed the review's launch had gone off quietly enough, with no really big rows with GPs. Because, all of a sudden, ministers flipped.

Tired of the familiar arguments over pay and extended hours, they scrabbled wildly around for a fresh target – and settled on the denial of choice of GP practice.

Ben Bradshaw, relishing his role as the baddest cop at the Department of Health, accused GPs of operating ‘gentlemen's agreements' to avoid competing for patients.

He pledged to provide all patients with a choice of practice – scarcely acknowledging that this choice is already there – and ushered in a new era in which GPs are offered cash payments to compete tooth and nail for patients.

Radical new vision

Those plans are detailed by the Government's primary and community care strategy, launched as part of the review last week, which provides a template for a radical new vision of general practice.

GPs are to be expected to act like the corporate entities ministers insist they already are, outselling each other and poaching each other's patients to earn cash prizes.

GPs are not naive, and are perfectly aware of the political imperative to offer patients information and choice.

Practices are not averse to blowing their own trumpets from time to time, and had shown their willingness to co-operate by signing up in large numbers on the NHS Choices website – a co-operation the Government has now placed at risk.

Because its vision for general practice is one many GPs will simply not recognise as having anything to do with healthcare.

As GPC chair Dr Laurence Buckman put it, GPs are specialists in family medicine, not shopkeepers.

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