To the Editor: The articles in the General Practice issue are most interesting. Sadly, the articles on how general practitioners are paid1-6 have largely missed the point. It is not only how GPs are paid, but also how much that matters. No matter how ideal the incentive incorporated in the payment method may be, if the quantum is too little even the most idealistic GP will find it impossible to work in a professional manner. Payment here includes both direct personal income and the associated practice conditions.

In most countries, changes in GP financing focus more on how to keep costs down than on rewarding quality. Green was the only author to address this issue, making the point that US family medicine organisations have recently changed from showing how good GPs can be to ensuring they are paid well enough to do that good work, and to provide incentives to encourage the next generation of family physicians.6

Since the introduction of the National Health Service (NHS) in 1949, the United Kingdom has gone through several cycles of declining incomes and conditions for GPs, followed by declining interest and recruitment, in turn followed by higher pay and conditions that attracted new recruits. Overall, UK GPs have been paid relatively well compared with their hospital specialist colleagues. It is no accident that the UK has developed the highest levels in the world of academic general practice, as well as research in practice, while the British taxpayers obtain the highest value from their overall health service.7

Currently, in Australia, the Journal classifieds confirm that there are vast discrepancies between expected salaries for specialist and GP services; perhaps there is a lesson for funding. Until salaries for GPs are similar to those for specialists, bright young medical graduates will prefer to work in higher-paying, hospital-based specialties. Merely altering the payment system will make little difference. The value potentially obtained from good primary care will remain out of reach unless the total resources put into this sector are increased.