May I add to the interesting paper by Dr Azeem Majeed on British general practice?1 The attitude of general practitioners towards their patients and their style of practice depends partly on how you pay them. There are three possibilities: salary; fee per item of service; and capitation. Each has advantages and disadvantages.2 The least desirable is the British method of capitation which serves to empower the doctor at the expense of the patient. If British general practitioners were switched to ‘fee per item of service’, attitudes would change overnight. Notices would vanish from waiting room walls, prompt appointments would become available and home visiting would be resumed. There is a lot to be said for a ‘Tesco’ NHS.3
Declarations
Competing interests
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References
- 1.Majeed A. General practice in the United Kingdom: meeting the challenges of the early 21st century. J R Soc Med 2013; 106: 384–5 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Porter AMW, Porter JMT. Anglo-French contrasts in medical practice. BMJ 1980; 280: 1109–12 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Supermarket NHS. Correspondence. The Times, 25–27 June 2013.