New incentives for general practitioners in London.

Abstract

The London Initiative Zone, encompassing an area of about 16 km radius from Piccadilly Circus, was set up by the Department of Health in 1993 “to concentrate attention and resources on developing primary care in the inner city.”1 Since then there have been schemes to improve general practice premises and expand primary care teams and community health services. General practice is the focus for primary care in Britain; but contented, keen doctors are likely to provide better care than unhappy and frustrated ones, and the morale of general practitioners in Britain has been steadily deteriorating.2 The Royal College of General Practitioners and the BMA's General Medical Services Committee have established task groups to review professional recruitment and morale and recommend ways of improving them.3 4 Low morale has many causes, including increasing workload and professional isolation, inappropriate administrative tasks, unrealistic patient expectations, and an uncertain future. In London as in other large cities, high costs, social deprivation, a high turnover of patients, and the impact of closing hospital beds all combine to increase stress, while vocational training often fails to equip doctors with skills necessary for inner city practice. Other important reasons for decreased job satisfaction and failure to recruit general practitioners include a lack of protected study time to keep up with the …