The government removes the ability of the GP to decide on clinical issues, by creating the guidelines to meet government targets and declaring them to be mandatory. We should examine why the government is interested in forcing your family doctor to follow a particular pathway. We should also ask if it makes sense for the government to pay (your already very well paid GP) large bonus payments to doctors just for doing the job that they were employed to do... that is looking after your health.
The usual effect of government guidelines in medicine is that they are intended to set a gold standard for clinical practice. We could expect that good family doctors are already keeping abreast of the latest clinical research and modifying their approach to treatment so that the patient is always the recipient of excellent healthcare. There will be many reasons why your family medical practitioner will not be up-to-date with current best practice. The spectrum of medical knowledge is very wide and the GP is a general practitioner, who will not usually have specialised knowledge about each of the diseases and conditions that they will see in routine GP practice.
Having a target for good health would appear, on its face, to be a very worthwhile aim. Globally speaking, our medical knowledge is added to daily and the responsiveness of the medical profession, to developing situations, will be affected if the guidelines of a government can only be changed once every few years, as is the case of the statin policy guidelines. For example, we hear a lot about the dangers of smoking cigarettes and every medical practitioner will have a litany of tales to tell, about the tragic consequences for their patients who have chosen to smoke cigarettes.
All of the government's guidelines, concerning the health of the nation, while laudable, are wasted if a patient continues to smoke. The effects of cigarette smoking are so severe that they will almost certainly negate much of the treatment that is designed to improve the cardiac health of the nation. Cigarette smoking is now banned in public places, ostensibly to remove the risk of passive smoking from non-smokers and smokers alike. It would be sensible to stop selling cigarettes in the UK if one wanted to make a real impact on the disease processes associated with smoking.
Paying family doctors to treat people so that government targets can be met, is a policy that is questionable. The combined knowledge of the medical profession has moved forward since the last set of guidelines concerning statins was mooted. The medical profession is starting to see well-considered evidence... that underpins the notion that statins are not particularly helpful and that they may well be creating very severe health problems for the population as a whole. As the anecdotal accounts become supported with hard research numbers, the individual doctors can modify their treatment regimes.
The government targets are now in the final stages of the process of being mandated (October 2007) and included as a part of every GP contract of employment. The department of health has been unwilling to listen to alternative arguments to their policy aims. That the government must pay GP's large bonus payments... to undertake the job that is implicit in their contract of employment as family medical practitioners, suggests that the system of targets for the national health is somehow wanting.
Creating incentives such as an extra £121,000 bonus payment to GP's, can only ensure the unthinking compliance of the family medical practitioner, with questionable targets that supposedly raise the health of the nation from one point to another. Mandating the targets (and including them within the contract of employment for GP's) is a mechanism for stultifying original thought and creative medicine. The climate of greed is fostered and supported by government and the health of patients is subordinated to a meme (high total cholesterol levels are the cause of heart disease) that is patent nonsense and completely unsupported by any medical research published to date.
