Contrary to cynical Whitehall watchers, there was nothing wrong with the objectives of the new GP contract. The negotiations in 2003 coincided with a genuine NHS crisis - unlike today's media-manufactured one - with GP surveys showing 25% were looking for an alternative career, 50% planning to retire before 60, and 82% complaining of an excessive workload. Worse still was their poor performance in preventive health. For example, half of all patients with high blood pressure were not diagnosed, half of those diagnosed were not treated, and half of the treated received inadequate treatment. Hence the new financial incentives to lift standards, widen service provision, and make more use of support staff.
What was neither planned nor intended was the unprecedented bonanza which the BBC reported yesterday: GP pay rising up to £250,000 a year. True, that was only for 1% or so. But average pay of about £100,000 makes them the best-paid family doctors in the world with the exception of the US. The mistake was already conceded by the health department as was the £300m overspend on GPs' pay. What went wrong was a catastrophic failure by management in calculating the financial implications - for which key officials have already been removed, but not ministers who have moved on. Worse still has been the degree to which GP services shrank in the wake of the pay deal. There is much better health monitoring but, at a more basic level, far fewer GP surgeries now open on Saturday mornings, fewer still hold late night surgeries, and only a minority are now doing after-hours calls. Belatedly, this is being addressed in this year's contract, where patient satisfaction surveys - which will include speed of access and appointment systems - will be included. The key issue now is what lessons were learned.
One of the problems of the GP contract - like so many Labour health reforms - was the number of other radical changes, some of them contradictory, being pursued at the same time. The prime minister has still not learned. In an address to the New Health Network think-tank yesterday he listed four big reforms which the government is pursuing. This month marks the nationwide introduction of payments by results, the biggest change since the NHS was launched 58 years ago, under which finance flows to hospitals, ambulance services, primary care and mental health teams according to the numbers of patients treated, rather than a block contract. On top of that, the government is expanding patient choice, introducing more independent providers and promoting GP commissioning. He could have noted two other reforms - both currently unnecessary - involving radical restructuring of primary care trusts and strategic health authorities.
Once again, there is nothing wrong with the government's broad objectives. We too want patients to have more say in the NHS. Mr Blair is right to want to "move from a 'get what you're given' service where the patients fall into line with what the service decides; to one that is more 'get what you want' service moulded round the decisions of the patient". The aim is right: reward the producers well, but insist in return that the user comes first. It cannot be done overnight. Payment by results should make the NHS more efficient and responsive, but it will take time. Overseas it took 10 years. Mr Blair wants it done in two because the record increases in spending ends in 2008. But it is foolish to apply across the nation a new system, which is known initially to create instability, when one quarter of NHS trusts are already suffering financial instability. This is not a recipe for morale-raising in troubled trusts. It will inevitably require suspensions in these districts, as happened overseas. That is not going to look good for the NHS or ministerial reputations. Let it begin, instead, in the many trusts where there is already stability.
