Why is the government shovelling yet more money to GPs?

Not only have ministers agreed to pay a minimum of around £50m to them for administering swine flu vaccinations - and that would only cover one jab each for the nine million most at risk - but they are also relaxing the quality and outcomes framework.

As money in the health service tightens, the government’s craven approach to GPs looks increasingly unsustainable.

GPs have the best of all worlds. They run as private businesses but are funded by the state in a way that insulates them from economic reality. Uniquely in the health service they can demand more money for extra responsibility, making a nice little earner out of swine flu while the NHS searches for cuts.

Sadly, the absence of a national patient records database means the Department of Health would have struggled to bypass local surgeries and administer the jabs through hospitals or primary care trusts. However, some deft media briefing about greed in a time of austerity might have brought the price below £5.25. The public would have had little sympathy for the notion that doctors wanted a profit from what could still become a national emergency.

In the long term government and PCTs cannot remain beholden to these private contractors. GPs’ relationship with the NHS needs to change.

An important step forward comes with the Care Quality Commission’s tougher inspection regime for primary care. This will begin to flush out bad services. As surgeries have largely escaped scrutiny until now, the CQC will be greatly enhancing patient care.

But more must follow. It needs to be much easier for PCTs to decommission a surgery without extortionate cost to the taxpayer if it can get a better or more cost effective service elsewhere. If services are too poor, too inflexible or too expensive the PCT must have freedom to pull out. That is the risk a GP should accept for being in the private sector.

An incoming Conservative government is committed to vesting more power in GPs by strengthening their commissioning role. The party needs to be sure such a move is the right mechanism for driving quality and efficiency - and is worth the risk of advancing the interests of a subsection of the British Medical Association which has proved remarkably adept at giving itself a shot in the arm.