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At the heart of general practice since 1960

Talking POINT

Dr Terry John, a GP since 1981, practises in Walthamstow, north-east London. He is

also a GP trainer.

Jo Carlowe asked him about the hot topics

in his practice.

Flu pay deal

The NHS Confederation and GP negotiators cite different figures on flu pay. Who do you believe?

I believe the negotiators. Time and time again the Department of Health suddenly confuses things because the right hand hasn't told the left hand what it's doing or because there is a deliberate attempt to destabilise things.

What action will you take if the negotiators fail to get their deal upheld?

We have a list of things being prepared by our PCT ranging from asthma management to treatment of coronary artery disease. I won't be distracted from these things by something that is not resourced.

Which is the greater priority for you ­ national service frameworks or quality points?

NSFs are like a bunch of sad partygoers waiting to be invited to a party. They come down like a production line, drawn-up by well-meaning academics, but without actual resources. At least quality points seem to marry up with what a good GP should be doing.

48-hour access

What is more important: 48-hour access for all patients or the facility for advanced booking?

Forty-eight-hour access is bonkers. It's a clumsy attempt by the Government to gain popularity. It should be dropped in favour of improved access.


Will the new enhanced service for violent patients work?

There is the capacity for it to work. In our area a GP runs a surgery once a week attended by a police officer. The scheme predates enhanced services. It works really well.

Enhanced services

What is your view on the Government's decision to allow PCTs to spend enhanced services cash on deputising services?

It is so unthinking. The Government is inviting PCTs to spend money on things that might not be appropriate and causing a further squeeze on the sums that are there.

Mental health

New research suggests racism, ageism and sexism play a part in the way GPs make mental health referrals.Is it easy to make this mistake?

We are trained to use services economically and it could be that we start to economise by selecting people for psychiatric services on the basis of their culture and intellect. In doing so we risk disenfranchising a whole raft of people.I think we have all been guilty of this. It's an area that needs far more study.


Applications for PMS are falling. Why do you think that is?

When the Government comes up with something new they throw loads of carrots at it and then they run out of carrots.


Should there be a ceiling on locum pay?

There can't be. The BMA had its fingers burnt by the Office of Fair Trading. Instead we need to make GMS more appealing.

And finally

In light of the flu-pay fiasco, sum up the relationship between the GPC negotiators and the NHS Confederation.

They have found themselves in a medicopolitical reworking of Laurel and Hardy where they say to each other: 'That's another fine mess you've got me into!'

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