Summary of responses

The editorial by cardiologist David S Wald on performance related pay (PRP) in primary care sparked 12 responses, mostly from aggrieved UK general practitioners (GPs).^{1 2} United in their opposition to Wald's suggestions for a “revised” quality and outcomes framework (QOF), several of the respondents point out that a hospital consultant may not be best placed to write about issues affecting primary care and the increasing complexity of primary care consultations.

Many are compelled to clarify that the QOF payments are not incentives for the GPs themselves. There may not be enough awareness of the changed ways of working and workloads that GPs have adopted, which, combined with their achievements in implementing new systems and targets, may justify a different system of pay and incentives. And measuring risk factors is only a part of preventive measures, not an end in itself.

Andrew Wijnberg, a GP in Birmingham, takes issue with Wald's comparison: “It is not fair to compare the QOF with paying police to catch criminals or firemen incentives to put out fires; the payments for performance are more akin to a performance pay for the police or fire organisation in achieving national standards in detection rates and prevention.”

One way out of GPs having to justify themselves every step of the way might be “to ask the public what it wants from their GPs and then pay GPs to provide it,” writes Ian Quigley, a GP from Romford. And in the only letter from outside the UK, academics Joachim Sturmberg and Carmel Martin identify that what matters for health systems is the improvements to the patient's health experience rather than the “simplistic approach of ticking process items that bean counters can understand.”

Mark Davies, university lecturer in law, detects that poor communication is fanning the flames: “Some of the general public are asking what exactly the taxpayer is receiving in return for the extra money pumped into general practice, and whether GPs are being paid extra for doing what a good doctor should have been doing anyway. Justified or not, it seems that the medical profession's communication with the public over this issue leaves a lot to be desired.”