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Federations a step to a wholly salaried future

Like more than a few GPs of my generation I am saddened, even shocked, at how some of my peers - having done postgraduate training years ago under conditions of semi-slavery - feel they can justify offering younger GPs blatantly exploitative salaried positions in their practices under conditions they themselves would never accept.

These positions are often accompanied by the hint that if these juniors put up with being ripped off, one day they may rise to the exulted position of partner.

To their credit the BMA and RCGP are campaigning against this - but I am not sure they have come up with the right solution ('GP leaders plan overhaul of "unsustainable" general practice').

Federations will be made up of independent contractors in name only. The only thing going for the idea is better organisation and as a way of smoothing in a true salaried service. Frankly, federations are a fudge.

Surely it is time for the Government and BMA to grasp the nettle and go for a properly resourced salaried GP service with decent pay and conditions integrated properly with other parts of primary care? GPs fresh out of training should be junior consultants in primary care, rising over time to be senior consultants like our hospital colleagues.

The large majority of hospital doctors are quite happy with employee status and all its perks, and don't miss managing a business for which they have no training at all. Everyone knows the days of the independent contractor model are numbered and a salaried service inevitable.

By the sound of it, the Government and the BMA are privately thinking along these lines anyway, yet neither side can quite get themselves to come out in public and say so.

Why wait?

From Dr Paul Caldwell, GP partner, Goole, East Yorkshire

I regard the RCGP and BMA plans as a potentially disastrous U-turn by our self-appointed leaders.

I have observed the profession changing over a number of years. About 10 to 15 years ago there began a tendency for newly trained GPs not to look immediately for a partnership, but to prefer to work as locums, salaried GPs or to do other things for a couple of years. They preferred the benefits of being an employee and the flexibility it gave to work part-time or reduce their out-of-hours work. A shortage of partners became evident, but this was largely because of the delay in new GPs seeking partnership.

A couple of years further along, there were complaints that there were not enough opportunities for new GPs to work in salaried posts. Practices took on board this message and began advertising for partner/salaried positions. This should have been welcomed by the BMA and by new GPs who had moaned previously about the lack of such flexibility.

But after complaining that practices were not offering partnerships, the BMA now wants us to effectively end all partnerships. It would turn us into essentially a salaried service, having to kow-tow to NHS managers. What has got into our negotiators? Does this really have the best interests of doctors and patients in mind, or is it politically motivated?

From Dr David Church, GP partner, Machynlleth, Powys


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