Bernard Dineen: The GPs who focus on money, not medicine

COMPLAINTS about out-of-hours care for GPs' patients have risen by 50 per cent in two years. They include the death of a pensioner given an overdose of diamorphine by an exhausted African doctor working in Germany who had flown over for the day to do his first shift in Britain. This is not the first case of blunders by doctors untrained in British primary care.

You don't become a GP in order to ignore your patients' welfare. Clearly, no GP can be on call 24 hours a day but GPs themselves took steps in the 1970s to organise out-of-hours cover. They set up non-profit making GP co-operatives, which were owned and administered by local GPs. The first was set up in Bolton in 1977, which made it possible for some doctors to take turns in doing night and weekend shifts. Patients knew they were being seen by a local GP and doctors were happy not to be on call all the time.

Eventually, there were 300 other GP co-operatives, with a network of 30,000 GPs providing out-of-hours cover to a population of about 30 million patients.

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Enter the clodhopping clowns from the Department of Health, who claimed they could provide a better and cheaper service without relying on local doctors. The GP out-of-hours contract with family doctors they negotiated in 2004 has been a disaster.

GPs were allowed to opt out of after-hours care by forfeiting a negligible part of their pay. The result was that there were just two GPs available for out-of-hours duty in the entire county of Suffolk. The system of GP co-operatives was destroyed at a stroke.

At the same time, funding was reduced so that trusts looked for cheaper contracts with the rash of companies which cashed in. The number of doctors was reduced as they were replaced by nurses, helplines and paramedics. So worried patients often opted for A&E departments at their local hospital, putting extra pressure on an already overstretched service (overstretched even more because of EU interference in the hours of junior hospital doctors).

This was not the only disaster in the 2004 contract. Obsessed as usual with targets, the Government linked pay to performance, and GPs were paid for supplying various services such as vaccinations, which had previously been regarded as part of the job.

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As a result, a Parliamentary committee reported that GPs' hours were reduced and productivity fell while their salaries rose by as much as 60 per cent. The BMA negotiators could not believe their luck and general practice, which had often been an unpopular career choice, suddenly attracted a flood of new recruits.

The family doctor was always the jewel in the crown of British family life and reducing the service to its present state has been a crime. I spoke with a senior consultant about a GP practice which we both knew and I said it had still maintained high standards. He shook his head sadly and said: "It's all about money these days."

MUCH of the discussion about the "illegal" invasion of Iraq is

moonshine. The notion that "international law" is whatever the UN Security Council decides is ludicrous. Its resolutions have correctly been described by a Cambridge professor of international law as "masterworks of cynicism, dishonesty and opportunism."

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If the Security Council had done its job properly, the invasion would never have taken place. Saddam Hussein should have been brought to heel when he defied the UN time after time. He was allowed to carry on because he was protected by Russia, China and particularly France, who were profiting from his intransigence.

It should not be forgotten that France had in the past been helping him to manufacture what he described as "the first Arab A-bomb" and it was no thanks to France that he failed.

Saddam's Foreign Minister has testified that President Chirac assured him that he would block any US invasion: that is almost certainly one reason for Saddam's recklessness. The UN's corrupt behaviour must bear its share of responsibility for the subsequent slaughter.

WHEN I inveighed against Labour's all-women shortlists, I had forgotten that the Keighley MP Ann Cryer had been on one of the shortlists back in 1995, as she now reminds me.

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Any system that produces an MP as good as her cannot be all bad. It is quite possible, as she says, that if Keighley Labour Party had not had an all-women shortlist, she would not have been chosen, and vulnerable Asian women would have been deprived of her staunch and courageous support over the years. I only wish the other products of the shortlists were half as good.

ANYONE hoping to discover the truth from a political discussion on TV is wasting his time.

Last week Channel 4 brought the Business Secretary Lord Mandelson face to face with his opposite number Ken Clarke. The result was a disgrace. Clarke was his usual rational, reasonable self: Mandelson was at his worst, smirking at his own cleverness, endlessly interrupting Clarke to score cheap debating points and making no attempt to discuss Britain's economic plight. Those of us who have a high regard for Mandelson's ability had hoped he had cast aside his old ways. But apparently not. He is still the same slippery operator that he always was.