Leading article: An unhealthy way to operate

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General practitioners now rank among our most well-rewarded public servants. As we report today, the average earnings of Britain's GPs has soared to £118,000. This represents a 63 per cent rise in doctor's take-home pay in three years, an astonishing increase by any standards. There is, of course, nothing wrong with paying doctors well. But the question is whether we, the taxpayers, are getting value for money?

Some £8bn a year is being spent on primary care, one third more than three years ago. Has the service offered by GPs improved by an equivalent amount in that time? The answer is no. They have hit most targets for which they are financially rewarded, but patients are still finding access to their local doctors restricted. The Healthcare Commission has found 12 per cent of patients are not getting appointments within two working days, despite government boasts of speedier access. It also found that one third of patients unable to book appointments more than two days in advance.

Doctors are failing to recognise this dissatisfaction. On the contrary, some want to go back to the days when they had the power to set appointment times themselves. Many doctors are also resisting "practice-based commissioning", something that would result in a welcome drop in hospital admissions and force GPs to be more responsive to patient needs. Despite their generous pay rises, too many doctors are failing to play their part in delivering the sort of health service the public demands and expects. Many of them are working shorter hours and providing a worse service.

But where does the fault lie? At the root of the performance problem is the contract negotiated between the Government and GPs in 2003. This was absurdly generous to doctors. As well as substantially increasing GPs' salaries, it transferred the responsibility for night cover to Primary Care Trusts. But it demanded too little in return.

The fact is that government has been stuffing the mouths of GPs with gold without requiring adequate improvements in their performance to match. This is emblematic of the Government's failure to reform the health service as a whole - pumping huge sums into an inefficient service.

The contract cannot realistically be renegotiated now. But Britain's 8,500 practices can still be made to perform better. The drive to establish more private surgeries and walk-in centres with access to public money must be stepped up. Patients must be able to vote with their feet if they feel their local surgery is underperforming. Competition has now become the only route to true value for money in the primary care sector.