As a PMS practice we were already comfortable with structured care, particularly in diabetes and ischaemic heart disease. At the beginning of the process of capturing data for the Quality and Outcomes Framework (QOF) we were fortunate to employ a truly excellent manager who went about this task with military thoroughness. The practice team has worked hard and each individual has contributed, so it has also been a good team building experience. We have achieved high QOF points and our income is likely to improve. Even better (O frabjous day!), we are no longer obliged to cover Saturday mornings or out of hours. Personally, I am much better off.
So, if I knew what I know now, would I have voted for the new contract rather than against? Should I eat my words, admit I was wrong, and humbly apologise to Dr Reid's cadres and to the GPC that this ignorant worm is now enlightened and grateful for their wisdom and foresight in making my life so wonderful? One way of approaching this question is to reflect on whether I would be quite so happy if we had to do all this without the increase in income, or if the removal from out-of-hours cover had not been on such ridiculously favourable financial terms.
The profession has essentially been bribed to implement a population-based disease management programme that often conflicts with the individual patient-centred ethos of general practice. As a consequence, the ideal of general practice with the consultation (and all its ramifications) as its most important transaction is being undermined by a centralised drive for population targets and bureaucratic indicators. And to anyone trying to justify these targets and quality indicators by claiming that they are ‘evidence-based’, I would observe that they are evidence-based only in the sense that a karaoke night is the same as a performance of The Magic Flute, or a painting-by-numbers kit the same as a Monet. The new contract comes dangerously close to medicine by numbers and, in the long run, threatens the professional basis of general practice, indeed its very existence as a specialty.