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An underclass of salaried GP serfs

Dr Jim Sherifi urges GP principals to take a long hard look at how they are treating their salaried colleagues

Dr Jim Sherifi urges GP principals to take a long hard look at how they are treating their salaried colleagues

A recent survey from The Information Centre revealed a huge increase in the number of salaried doctors working in primary care. Its findings should have come as no surprise to anyone with access to the jobs pages of any medical journal.

There has been a doubling of the number of salaried doctors in primary care, to 17% of the workforce, in the two recorded years following nGMS. As every GP partner retires, so he or she is increasingly likely to be replaced by a salaried doctor. Even the ads 'with a view to partnership' are no longer seen.

This trend is almost entirely the result of the shift in doctors' remuneration from payment based on an individual doctor's work to a share of practice income. It did not take long for those principals seated at the table to realise that the size of the slice of the monetary cake was indirectly proportional to the number of slices.

With that simple reality, Kenneth Clarke's disparaging comment about doctors and their wallets was tragically proved to be true. The 2004 nGMS contract applied the concept of 'bums on seats' to a whole new arena. In one stroke GPs were set upon an internecine collision course between the haves and the have-nots, based purely upon who was lucky enough to have been a principal at that time.

I have never been a paid-up member of the conspiracy club. Ministers are too incompetent to set out a strategy for a more controllable 100%-salaried service. Instead we have decided to do it for them. We are even losing the support of the public who now think of doctors in the same bracket as football prima donnas and City fat cats without realising that this only applies to GP principals.

Nobody wishes to think badly of a colleague but the fact is that in general practice there is now an underclass of employed doctors who have become GP serfs. Apologists state that salaried GPs are better off because they can have a 'portfolio career', fixed hours, a defined workload, an emphasis on clinical rather than administrative work and so on.

What they choose to ignore is that whereas choice is the buzzword in public services, it has been removed from a significant proportion of working doctors.

Is it that much harder?

Is being a principal really so onerous? Is the difference in workload, which is mainly administrative, so great that it warrants a 50% premium on income or a different, and arguably more lucrative, pension scheme?

Those currently in partnerships need to take a serious, hard, long-term look at the future when next deciding upon replacing a partner. If these inequalities remain then there will be huge schisms within the profession. It will not take salaried doctors long to become unionised and militant. Heaven forbid that doctors should ever go on strike against their employers – other doctors – but such a scenario is likely if we do not take heed now.

Now I see that another survey by a company of medical accountants reckons that the proportion of salaried doctors will peak at 20% because 'there is more interest from younger doctors in partnership'. Get real! The interest has always been there. It's the opportunity that has been taken away.

The beauty of partnership lies in the word itself – an ethos of togetherness and mutual support. Sadly, it is that which is the greatest casualty in this selfish world. There is a baseness of behaviour here that is sad to see in what was previously such a proud profession.

Dr Jim Sherifi is a salaried GP in Sudbury, Suffolk – he was a GP partner for 20 years

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