Joan Smith: For a really healthy pay rise, consult your doctor

If I were a trade union leader, I would have been gazing at the British Medical Association with awe and envy last week. How on earth did the doctors' trade union manage to get GPs such a huge pay increase for actually doing less work?

It all arises from the latest GP contract, which allows doctors to opt out of out-of-hours care and is "not a good deal" for taxpayers, as the National Audit Office observed with laconic understatement in a review published on Thursday.

The BMA doesn't have a silly name, like Amicus or Unite, but it has clearly done an amazing job for its members; the earnings of partners in GP practices (not salaried GPs, whose increase barely kept up with inflation) rose by 58 per cent over the two years to March 2006 while their workload dropped by around seven hours a week.

I'm amazed BMA leaders did not have to treat each other for shock when they saw the deal they'd got out of the Government.

I'm not sure why the Government didn't realise how much it was giving away– £1.76bn more than it intended – without getting the expected improvement in patients' health, but the problems caused by the GP contract are symptomatic of larger failures.

Each time I hear ministers reel off the amount of money which has been poured into public services since 1997, I wonder why they didn't make it dependent on delivery. Paying people more doesn't necessarily make them more productive or increase their sensitivity to what the public wants, as the extraordinary saga of GP earnings demonstrates.

There's no doubt that public sector workers have better pay and conditions after 11 years of Labour government, and I have no quarrel whatever with the idea that they should be rewarded properly.

But we are entitled to expect consistent and user-friendly levels of service in return, rather than what health professionals or other public servants feel like providing. One of the aims of the new GP contract was to attract more doctors into general practice, in which it has succeeded, but it's no easier to see a doctor – rather the opposite, in my experience.

Average earnings of GP partners are now £113,614 a year, which is a figure to keep in mind next time you struggle to get an appointment. The numbers rise unbidden before my eyes each time I am told to call back at 8.30 in the morning or 1.30 in the afternoon, putting me in competition with every other mildly unwell and chronically sick person in my part of west London.

It's like taking part in an auction on eBay, and the combination of luck and persistence required has nothing to do with medical need.

This ludicrous system seems to be in operation up and down the country, while other practices expect people who want "emergency" appointments to turn up at the surgery just before it opens and wait in biting wind and rain. No matter how good care is once you get it, the whole system falls apart if there is a problem with access – and that's the story I hear all the time.

Like other people who work in the public sector, GPs are still providing a service which is tailored to their needs, not those of the taxpayers who fund it. It is one of Labour's most egregious failures, and Gordon Brown should appoint a minister to monitor delivery in the public services without further delay.

Oh, and my advice to trade union leaders is very simple: from now on, don't even think of opening pay negotiations without a doctor on your team.