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GP's Medical Ashes challenge

Employing hospital consultants in primary care may cost less than a GP with a special interest, according to the NHS Alliance.

With GP income rates outpacing growth in consultant salaries, the cost of supervising and training GPwSIs, and the premiums they command for their skills, it could be more economic to use consultants, says Dr David Jenner, GMS contract lead for the alliance.

The case is strengthened as the consultant workforce is growing at a faster rate than that of GPs, he said. Further savings could be made by practice-based commissioners if retired consultants were employed ­ as they would not need to be superannuated.

Dr Jenner, who is considering such a move, said: 'There are not enough GPs to do the day job let alone the extras. Depending on the market rate and whether trusts will release them, you could employ consultants. Sometimes that will work out cheaper.'

He believed primary care could undercut new hospital payment-by-results tariff levels by half ­ and margins increased even more if consultants were used.

'I have done the costings and it's a reasonable option while there's a national shortage of GPwSIs who want a premium to replace time from their partnerships,' he said.

But Dr John Pittard, a board member of the Primary Care Cardiovascular Society, which promotes high-quality cardiovascular care in primary care, said the cost of consultants would depend on local market forces as there were no national rates for GPwSIs.

'A lot of consultants are on higher rates than would appear because of merit awards and the new contract,' he added.

Dr Graham Archard, vice-chair of the RCGP, said consultants may be more efficient and see more patients than GPwSIs for given specialties.

But he warned it was a mistake to compare the two only in financial terms.

'GPwSIs provide an aspect of secondary care specialty but with a generalist role involved,' he said.

By Ian Cameron

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