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Heath seems to have lined up beside the journalists, politicians, and health economists who, after none too subtle signalling from the government, have queued up to give general practitioners in general (and the new contract in particular) a good kicking.1
The Quality and Outcomes Framework (QOF) has meant that, for the first time, large areas of evidence based care have been provided across communities by practices at funding levels well below those charged in the payment-by-results tariff of other NHS organisations. General practitioners accepted this challenge on the basis that if they failed to deliver they would not get the funding—a challenge never before accepted by any other type of NHS organisation.
Continuity of care is closely related to whether practices have personal lists, how they deal with same day and future appointment requests, and whether the doctors are full time or part time. Whether the contract is with the practice or the individual doctor makes little difference.
There are now more employment options and opportunities for flexible working. Staff numbers and pay are increasing, according to accountants' organisations and the Department of Health.
Criticism of the new out of hours arrangements is mostly directed at general practitioners, although these services are the responsibility of trust managers, who have deliberately chosen not to employ more doctors in out of hours work and avoided all criticism by the media and government. It is difficult not to conclude that politicians are manipulating media comment to force general practitioners to go back to their personal 24 hour commitment—although the government's workload survey show that full time general practitioners already have working hours close to the European directive maximum.
Competing interests: GW is a GP partner.