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Why GPs must now accept changes

Re: the letter by Dr Ken Mathews 'Outsiders have a hidden agenda with our contract' (June 2). Having worked for a number of years within a practice, a health authority and now PCT, I feel I have a qualified and slightly different perspective.

It is not so much about using the contract 'to their own advantage' as Dr Mathews suggests, but about modernising a struggling health service. If 'to get there from here' requires radical change then it must happen without egos, past prejudices and an attitude of 'it has always been this way' getting in the way of progress. Let's face facts ­ there is not enough money to provide for the aspirations of the national service framewoks, National Institute for Clinical Excellence and so on, but with some re-engineering and some fundamental rethinking of how services are provided, we might get some way to providing a better service for patients. After all, that's what we are here for, isn't it?

Dr Mathews is right when he says 'others appear to be developing their own strategies' though. PCTs should be supported in being accountable for public monies. If contracting to provide services that have traditionally been provided by GPs means there is some competition with other health care providers, surely this is a healthy situation seen in all other areas of business?

Providing the checks and balances are in place, the process shows due process, and mindful of the lessons learned during the period of the internal market. While the current situation may be unpalatable to GPs, given the current agendas, change is inevitable ­ so why not be part of it?

Christine Macrae

Director of Prescribing

Broadland PCT, Norwich

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