Leading article: Some unpalatable medicine

Our revelation last week that the average take-home pay of a family doctor is now considerably more than £100,000 a year has prompted quite a reaction. We have been inundated with correspondence from GPs defending their pay. Some make valid points. It is true, for instance, that most GPs are now more "productive" in several ways than they used to be. Doctors routinely check blood pressure and perform minor procedures in surgeries rather than referring patients to hospital. We would not argue that this general increase in productivity should not be rewarded.

The problem lies in the question: how well rewarded? None of our correspondents has fully engaged with the fundamental point that GPs are now taking home a considerably higher percentage of the gross sums they are handed by Primary Care Trusts to run their individual practices. GPs' "profits" have risen from 40 per cent to 45 per cent in space of one year. As the Health Secretary Patricia Hewitt confirmed yesterday, this is not what the Government intended when ministers signed the new GP contract with the British Medical Association two years ago. More of the increase was supposed to go into patient care at surgeries, rather than directly into doctor's pockets. The contract was badly negotiated.

This is an issue that goes beyond the narrow question of GPs' pay. A considerable amount of the huge spending increases on the NHS in recent years have been swallowed up by poorly thought through pay deals. The fact is that patients are not getting the value for money from the health service they deserve. Rather than rejecting any criticism of their pay increases, doctors ought to consider this bigger picture. Many patients continue to find basic access to their GPs less than satisfactory. There is a clear demand for surgeries to operate at weekends and with more flexible hours in the week. Yet few practices operate like this.

Ms Hewitt says the Government should have restricted the proportion GPs can take out of their practices under their new contract. No doubt this is true. But surely the time to start facing down the vested interests of the heath service was seven years ago when the funding injection began. The unpalatable truth is that Ms Hewitt is now effectively admitting that we have had another seven years in which the fundamental issue of NHS reform has been ignored.