Editor's blog 3 July 2008: Ben Bradshaw - GPs' "gentlemen's agreements" block patient choice

“I think there’s also no doubt that there are some areas where gentlemen’s agreements operate that mitigate against lists being open to new patients, and therefore work against real patient choice”
Ben Bradshaw MP, Health Minister

Just when it looked as if a tentative peace might be breaking out between the Government and the British Medical Association, Health Minister Ben Bradshaw has told BBC News Online that Minimum Practice Income Guarantee funding (MPIG, agreed in the new 2004 GP contract) "dampens any incentive a practice might have to expand their list".

The BBC story reports Dr Laurence Buckman of the BMA's  GP committee dubbed Bradshaw's claims as "absolute nonsense ... it just doesn't happen". Buckman told the BBC's Nick Triggle that he is not opposed to moving the funding basis from MPIG lump sum to one based on practice list size, but that GPs were not going "to compete for patients, that is not the way general practice works".

It's interesting that the Government have gone so public on this one. Bradshaw is being deployed like a lightnining conductor, to have the rows with the BMA. He was scarcely conciliatory on Monday night's Newsnight coverage of the Darzi review, whereas the BMA's public faces and statements have been more measured over the past few weeks.

How big an issue is choice of GP for the public? It is of course technically possible at present, if you can find a practice with open lists. The current system provides a financial disincentive, in the form of initially lower payments for new patients. Yet the rate of switching is low. Is this a chicken-and-egg situation?

Playing the customer
Bradshaw adds that "it's the patient who pays the salary ... all too often in the heath service, the approach has been a kind of patronising 'we know best' one, when actually you're being paid by your patient, so your patient should be in charge. that's still a cultural challenge that we still need to crack".

Oops. The 'we pay your wages' argument is not really the world's most sophisticated management approach, is it?

No, even by reactive political standards, this brand of megaphone negotiation tells us two things. Ministers now believe that there is political capital and mileage in attacking GPs. And they are going to be playing hardball.

By the way, did you notice that the Darzi primary care strategy has been held back a day? It was definitely scheduled for Wednesday. Could these events be related?