The dirty semi-secret that GPs get paid per item of what they do – for example, immunisations, cervical smears, blood pressure checks – has been making me uncomfortable for years. I still do not know what the best way of paying GPs is. The Sunday papers this weekend are full of stories about GPs being paid not to send people to hospital. This is only the tip of an unpleasant iceberg. Professional medicine should be about doing the right thing for patients. And while doctors should have an eye on the cost effectiveness of potential interventions, and should not be wasting public money, there should be no personal financial gain involved.

What would be a better way? On one hand, the ‘independent contractor’ model (where GPs contract services to the NHS) at least has the chance to try and negotiate a decent professional contract. On the other hand, this hasn’t been achieved; would a standard contract actually allow professional values to flourish? Maybe a flat pounds-per-hour would be better; good practice could be audited by peer review and patient feedback. Not to mention a proper assessment of prescribing practices and referral rates.