Terence Blacker: Now weed out all those idle and clueless GPs

It was a Saturday morning and the doctor was bored. He was on weekend duty and it had been his number that I had been given when I had become concerned about a friend of mine. Normally a healthy, energetic man in his early sixties, my friend had, over the previous few days, been saying some distinctly odd things during telephone conversations. He lived alone and, when I visited him that Friday, he had seemed well enough physically, if rather thin, but his conversation had been uncharacteristically confused and sometimes downright weird. He was imagining visitors and events, forgetting familiar facts.

I told all this to the GP. He was unimpressed. There was nothing, it seemed to him, which could not wait until Monday. I persisted and, in the manner of someone humouring a tiresome hysteric, he agreed to see my friend at a walk-in surgery later that day.

The surgery was empty that Saturday afternoon. The GP sat in his office, reading a magazine. He would talk to my friend alone, he said. The consultation lasted five minutes. Tiredness was the problem, the doctor had concluded. What was needed was a good square meal. My friend might go in for a check-up with his local GP some time.

Over the rest of the weekend, the situation grew worse. My friend's own GP saw him on the Monday morning. A blood test was taken. The results, he said, would be back within 10 days.

But by now it was clear to everyone except the doctors that waiting for another 10 days was not an option. My friend was taken to accident and emergency at the local hospital. A neurologist was called in, a scan taken. A brain tumour was discerned on the left frontal lobe, and it was inoperable. Just over five months later, my friend was dead.

That all happened last year but I have found that the memory of those idle, clueless doctors has been difficult to shift during the recent debate concerning GPs' salaries.

Three years ago, at a time when the strain upon local doctors from overwork and inadequate compensation was such that many were said to be about to leave the National Health Service, they negotiated an agreement with the Government. In return for a 6 per cent reduction in salaries, they would not be obliged to work in the evenings or weekends. Crucially, a new system of "quality payments" would be introduced, providing rewards for efficiency and extra services.

It was a sweet deal, we now discover. In the three years since it was made, those quality payments have lived up to their name, landing a 60 per cent increase in salaries. On average, a GP now earns earn £106,000, while those who work overtime, like the magazine reader who saw my friend, are said to take home more than £200,000 a year.

The settlement was "just stunning", one of the negotiating doctors confessed on this week's Radio 4 documentary The Investigation. "Nobody in my position had ever believed we could pull it off, but to get it for 6 per cent was a bit of a laugh."

When the subject was raised at Prime Minister's Question Time, Tony Blair took a robust line. "There's nothing wrong in our GPs being paid the best in Europe if they're providing the best service, and I believe they are," he said.

Does he honestly believe that? There is now surely ample evidence that a deep cynicism is to be found among many GPs, with a lack of sympathy - sometimes even a lack of interest - in their patients. Doctors like to say a certain hard-heartedness is required in their profession, and it may well be that the business of dealing with malingerers and bores on a daily basis can instil a jaded attitude, but, as many of our 42,000 GPs prove every day, it is possible to provide a good service, in spite of the irritations.

A few miles away from the surgery that let down my friend so badly, there is a health centre whose doctors are straightforward and helpful and whose infrastructure links up well with other parts of the NHS. The doctors there fully deserve their improved pay.

Is that so difficult to manage? GPs hold a respected position in the community, but for too long many of them have blamed the system or their patients for their own inadequacies.

In virtually any other profession, the lazy and incompetent doctors who saw my sick friend might have been called to account in some way. Because they are GPs, the very idea is laughable. We have become used to having a low expectation of local doctors. As they help themselves to an ever-larger pay packet, the rest of us are expected to take our medicine and keep quiet.

terblacker@aol.com

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