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At the heart of general practice since 1960

Penny pinching is no way to drive up NHS productivity

So the think tank Reform believes GPs are not worth their money ('Cut GP pay by 10% and charge for appointments, think tank argues').

What exactly is productivity in regard to healthcare?

Is it the number of patients seen, or the number of operations done, or how many bodies there are in the crematorium?

Sure, the NHS wage bill may have increased sharply to £13bn, but the number of doctors has also increased rapidly over the past five to 10 years, so there are simply more of them to pay.

And if you reduce beds and have more consultants but keep the number of theatres in check, then you're not going to get increased productivity - do the maths.

As for charging patients for consultations, this sounds like a way of strangling off GP access (which is contrary to the drive to improve access through initiatives such as extended hours).

I think there is a background level of referral - like radiation - and the more GPs there are, the greater the number of referrals.

But limiting GP access and reducing referrals will store up a mass of undetected pathology and be a return to the dark ages of the early 1990s.

From Dr Spencer Nicholson, formerly Salford, now working in Australia

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