Column

The best of a bad job

There’s a new scheme to pay GPs for health promotion work. Rosa Hudson isn’t enthusiastic

Since I last wrote in healthmatters our health centre has suffered another tidal wave of forms and meetings. After moaning about 3 yearly health checks which were nonsense and which we never did, we settled quietly into the 1990 GP contract, realising that, although there were some idiotic things about it, we were at least getting rewarded for things we did well and had been doing unpaid for years.

Our Well Man and Well Woman clinics flourished and we developed a new breast feeding health promotion clinic. Some years ago a patient’s group ran a similar service but it fizzled out and breast feeding rates, at six weeks post-natal, had dropped from over 50 per cent to just over 40 per cent. The clinic is now well established and the rates have climbed back up. We consolidated our drug dependency clinics, with an ever increasing number of patients on methadone maintenance or gradual withdrawal.

But the government has realised that there’s money to be made by GPs in health promotion and have changed the rules of the game after only three years. Yet another ploy to burn out all but the toughest. Of course, those who did well out of the increase in capitation fees last time round are sitting pretty. Just have a big list size, do the minimum and roll in the loot.

For us, life is not so easy. Under the new system payments are made by ‘banding’ health promotion activities, but is geared towards coronary heart disease prevention. Even going for band 3 - the most highly paid - will lose us over £10,000 each year. That may not seem much to a highly paid GP but we are struggling to survive as it is.

When I was on maternity leave I had to pay for a locum for two out of my six months off, which cost well over my income. Our health centre, owned by the local health authority, has been broken into so often that our insurers are refusing to shell out the first £2,000 of each theft. Just when we discovered this, two partners had their medical bags, full of drugs and equipment, stolen and burnt in a nearby street. Replacement cost: £600.

At first we reacted to the new health promotion rules by trying to be positive, seeing it as a means of local practices getting to know each other before starting on neighbourhood commissioning. We already join with other practices in developing stop-smoking groups. We are contacting local sports centres to set up exercise programmes. But at a practice meeting the other day we sat back and thought: how long can we go on being positive, making the best of it when we feel angry and undervalued? Our FHSA is helpful and progressive but it can’t change the rules.

Our region has just created 10 posts for ‘trouble-shooting doctors’ to go into under-developed practices for two years, at £30,000 per annum plus a car. Perhaps we should all resign and do that. Then we’d be able to afford child care and support our loved ones. But - oh dear - it seems they want doctors who have just finished their training...