Derek Peedell casts light on a substantial issue in the governance of the NHS (see [2009] Gazette, 7 May, 11). GPs are publicly funded to meet the entire cost of the provision of GP services to their NHS patients. However, the GP is normally a private enterprise – typically (although by no means exclusively) a partnership. In the course of the provision of NHS service, that enterprise develops a relationship with patients and holds a substantial body of data about patients over which it asserts rights of ownership which it claims are not inconsistent with the rights of the patient, or of the NHS.

As the holder of that data it is in a strong position to exploit that monopoly position in relation both to the outside world and to the patient.

The efforts of British Medical Association negotiators over the years have been directed towards balancing competing pressures. The association clearly wishes to maximise members’ incomes while being seen to moderate the conduct of some more commercially minded members in their pursuit of additional income. It did this, to some effect, in arranging fees and support for the handling of GP records for the coal litigation.

Given that the state is funding the NHS costs, any income derived from additional services such as the completion of a COP3 mental capacity form is effectively profit. I wonder how much clinician time is involved in obtaining and considering the record and completing the form?

If a GP working full-time were to get an income of, say, £90,000 (a modest estimate), then your GP is receiving four hours’ pay for a single form that s/he is completing in order to ensure the proper protection of a patient to whom they owe a profound duty. Nice work if you can get it...

Chris Hughes, Streatley, Bedfordshire