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We've one safe sanction

In common with every other GP in the land, we accommodate the underfunding of the NHS by delaying investigations that have a low diagnostic yield, by accepting community care of patients who might be better of referred for admission, and by treating our patients with medicines that are less effective than those that are more expensive.

We also often advise patients to obtain medicines by purchase from pharmacies although they are entitled to free prescriptions. This is uncomfortable for us all but it does lead to more efficient use of scarce resources.

Now our negotiators and the Government have drafted a new contract for us which is likely to increase our administrative workload and, in the case of this practice, lead to a reduction in payment for services included in the global sum element of the contract.

We gather that the Government will not wish to renegotiate elements of the contract if the profession rejects it.

Our primary care organisation has underspent Government funds intended to incentivise general practice under GMS and appears likely to redirect the savings to the secondary and community care sectors, which have massive deficits.

If these sectors are to be allocated these funds it seems sensible that patients should follow the money.

A safe sanction for GPs inclined to vote No will be to cease to use our economic discretion in investigation and referral of our patients, and instead to practise safe and defensive medicine in these respects.

Dr Mark Chambers

Dr AJ Munro

Dr SA Marwaha

Cranford, Middlesex

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