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Conlon concludes in his editorial on regulation1 that GPs need to make a personal choice between independent and interdependent practice, but this seems a false dichotomy. Most GPs are both independent in the sense of practising unsupervised, and interdependent in that they work with, and are supported by, other professionals and GP colleagues, particularly in practice teams.
His vision of a supportive organisation, in which doctors welcome performance measurement and scrutiny as ways of understanding and improving their work, is attractive. Unfortunately, given the lack of understanding and appreciation of the roles and efforts of doctors shown by Government and the Department of Health over the last two decades, the NHS is unlikely to become such an organisation.
Besides, it is still questionable whether it is possible to develop measures of GP performance which are meaningful and useful enough to justify the costs, especially in doctor time, of their development and application. However good the measures, making them part of the appraisal in today's NHS would risk undermining appraisal's supportive and developmental role, and reducing the number of GPs who value it to even less than the disappointing 40% reported by Colthart, et al2 in the same issue of the Journal.