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Why politicians don't think we're worth the money we earn

We have just enjoyed the end of the party conference season, and for those of us who take a passing interest in politics it has been an interesting three weeks. Interesting, but profoundly depressing.

We have just enjoyed the end of the party conference season, and for those of us who take a passing interest in politics it has been an interesting three weeks. Interesting, but profoundly depressing.

If you study at any length the health care systems of other countries, you can see the comparative weaknesses and strengths of their systems. I don't think any country has a system that is quite like ours, and as a result the politicians have seen fit to make frequent pronouncements about the NHS. Every pledge and every pronouncement of course has ramifications for all of those working in the service.

I was once very excited about the way in which I thought the NHS might go. We had the Wanless report, and a commitment to increase the funding of health in the UK to the European average. Having worked in a system for a very long time, I was aware of what we had managed to achieve with a limited budget, so I thought we would be in a system that would be the best in the world.

I hadn't bargained, however, for the political mind. Ever since Tony Blair became prime minister he was surrounded by a coterie of ‘special' advisers who were appointed and listened to because they were ‘on message' for the New Labour mantra. That was to set in train the surreptitious break-up of the NHS into managed units, and to develop the philosophy of choice. The ethos of the market was to be bought into the health service to ensure that all the front-line workers were in competition with each other for ‘customers'.

We are not like supermarkets, however. I am not in competition with the practice down the road. We do not see them as rivals, but as colleagues. We were very happy to work in an out-of-hours co-operative to cover our area. That worked very well.

This was not the philosophy that the Government wanted. They wanted competition and not collaboration, and muttered darkly about doctors being anti-competitive and working together.

The first inroad into the old structures was made by the creation of foundation hospitals. Then the out-of-hours service was to be run by private providers. I calculated that the amount of money that the Government wanted me to earn for my out-of-hours work was 97p per hour. So when they offered a deal like that, and valued our services that derisorily, of course we took it.

I do not miss out-of-hours at all. My patients do. The service has ended up costing a lot more, and being very inferior to what we offered. But when the Government value us that little, what can you expect?

The 2004 contract was a triumph for the BMA. It happened, I think, partly by chance, but credit should be given where credit is due. The Government instituted the Quality and Outcomes framework (QoF) as a form of performance-related pay. The problem with performance-related pay is that if people perform, then you have to pay. It is not our fault that they set the bar as low as they did.

So now we are being told that our pay is to be frozen till 2011. That means a year-on-year reduction for most GPs as they have to pay cost-of-living increases to their staff. This is what has been happening since 2004, so we are used to it.

But the message it is sending out is that Government think we are not worth the money we earn.

That is depressing.

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