TY - JOUR T1 - Bureaucracy in general practice: time to halt a proliferating malaise JF - British Journal of General Practice JO - Br J Gen Pract SP - 696 LP - 698 DO - 10.3399/bjgp09X454241 VL - 59 IS - 566 AU - Edin Lakasing AU - Heather Francis Y1 - 2009/09/01 UR - http://bjgp.org/content/59/566/696.abstract N2 - Almost all of us who work in health care will be aware that the past few years have seen a significant rise in bureaucracy. The medical and nursing professions have had to absorb a raft of clinical guidelines and protocols, and primary care trusts (PCTs) expect practices to have their own guidelines on virtually all matters affecting administration, employment law, training and disciplinary procedures. In this essay we shall argue that this bureaucracy is excessive, and part of a concerted drive to undermine professional values and morale without offering any extra protection to patients. We also argue that regulatory bodies have colluded with this, and should instead take a more proactive lead in stemming this culture.In the interest of fairness we acknowledge that not all recommendations for how primary care works are necessarily bad. Few would argue against staff being trained in resuscitation or child protection, in preparation for those rare events when prompt action may save a life. The tenets of evidence-based medicine1 upon which the Quality and Outcomes Framework (QOF)2 rests are broadly sound, although the jury is still out as to whether NICE will consolidate any gains now that they are overseeing this. However, our recent experience is that many recommendations make no concession to common sense; the following are but three examples. Our local PCT insists that consent for childhood immunisations be in a much greater detail than established national guidelines.3 Non-clinical chaperones now require full training, at a cost of £80 and a day away from work. Choose and Book has been implemented, but is a tedious exercise of doubtful benefit to patients, and has certainly distanced GPs from our consultant colleagues.This trend has been occurring for many years; however, certain pivotal events have accelerated the process. Harold Shipman certainly … ER -