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Two points

Cassander you have clearly never noticed that people in posh areas tend to complain more, get listened to more and change practice if their issues are not addressed. This tends to drive up the quality of GPs in posh areas (note the word tends).

Two years ago the inner city PCT near where I work had finally managed to get approval (including LMC approval!) for a serious quality and performance management system. This included opportunity to improve followed, if necessary by contract sanctions. They had started the first round of visits, under-performing GPs had been given a deadline to produce a development and improvement plan.

The secretary of State announced that we were all useless and were going to be sacked. GPs would run it all and managers had better suck up to GPs if they wanted to keep their jobs. Result - the good people left, the performance frame work was dropped, the GPs identified as underperforming have done nothing about the quality of their practice.

It will take another two years for the LOAs to get themselves sorted and strart performance managing those practices again.

If improving general Practice is so important, what a shame we will have lost 4 years of making it happen