Just stick to the facts: remember Goodhart's law.

Abstract

> > Doctor Bell fell down the well > > > > And broke his collar bone > > > > Doctors should attend the sick > > > > And leave the well alone. Accusations that GPs are responsible for increased accident and emergency (A&E) attendances and slow cancer referrals prompted me to look back to an article that I co-wrote in 1995 outlining the lack of evidence for policies that affect daily practice.1 In 2008 Iona Heath2 described similar issues, stimulating comparisons with Goodhart’s law, ‘when a measure becomes a target it fails to be a good measure’ . The 1990 contract was imposed using free market principles. Academics with a dream of sustained perfect health colluded with government free-market ideology. Health became a commodity. Your GP would satisfy your greed for health. Science then and now, prophesied an undeliverable outcome. The greatest determinants of health are genetics, poverty, inequality, and education, controlled by governments not GPs. Struggling to balance reactive care with target-driven proactive care we warned of dangers to come. We described ‘moving away from listening and responding to talking and telling’ .1 Seeing all patients the same day, inappropriate consultations were an education opportunity. In others, the opportunity to instantly address a longstanding but hidden problem was seized. After 1990, unsolicited judgement on smoking and lifestyle invaded the patient agenda prompting guilt about illness and risking further concealment. Computer-prompted inquiries now compete with complex cases and careful, patient, and thorough practitioners have poor timekeeping electronically audited and their style criticised. General practice is part of the …