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At the heart of general practice since 1960

GPs standing at election enjoy mixed fortunes

When partners leave a practice has the opportunity to reassess skill mix, as Dr John Couch points out in his article (Features, April 30). However, salaried GPs or nurse practitioners are not necessarily cheap alternatives to new partners.

Salaried clinicians are protected by employment law, and can bring heavy obligations to small practices. For example, provision must be made for legitimate absences.

And salaries must be found before profit can be divided. Should the salaried GP become surplus, they are entitled to redundancy pay, perhaps taking into account all their NHS service.

Having recruited salaried GPs, I find them usually hot on clinical performance and cold on administration.

I have trained, introduced, and worked alongside nurse practitioners. They bring unique benefits and relieve workload.

They are not proxy GPs, and need medical back-up. While they 'cost half as much as a salaried GP' they work a different range at a slower rate.

If having more salaried clinicians in primary care results in higher income for partners, the NHS will be quick to adjust net practice remuneration. Meanwhile, salaried clinicians will press for more equitable pay.

As Dr Couch advocates, consider your needs and if you need a partner then seek one. If salaried options are considered, the implications must be fully anticipated.

Dr Carl Simpson

Ellesmere Port and Neston PCT

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