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Why do we reward failure at expense of success?

The history of 'the pool' ­ the money from which GPs are paid ­ goes back to the beginning of the NHS. Although the existence of such a pool was frequently officially denied, GPs suspected that it explained why no matter how hard they work for the NHS, running as some put it 'like hamsters on a treadmill', they never earned any extra money. One of the major achievements of our GMS2 negotiators was to eliminate the pool.

Imagine my surprise at a recent meeting addressed by a senior official from the Department of Health, Social Services and Public Safety when I was told the money to finance the development of GMS2 in Northern Ireland was contained in a specific 'envelope' and money spent from it to finance the new out-of-hours services would mean less to be spent on quality and outcomes payments and enhanced services. The official concerned should know. He is charged with implementing GMS2 in Northern Ireland.

Further questioning confirmed that indeed the department had every intention of viring money from the quality and outcomes budget to support the development of out-of-hours. Historically Northern Ireland has very high levels of GP activity out-of-hours, although no one has ever suggested this leads to better health.

The official agreed this would mean moving money from evidence-based activities that would improve health care into other activities that would not.

I feel this is yet another example of Miller's Law which states that the NHS, in Northern Ireland at least, will always reward failure at the expense of success.

This principle first came to my notice during fundholding when it was apparent that successful trusts were always expected to perform above contract while failing trusts were shored up by supplying more money.

I am sure colleagues across the water have noticed similar examples. I would be grateful and relieved to hear from colleagues of instances in the NHS where Miller's Law did not apply!

Dr Lewis Miller


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