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GPs go forth

All GPs will go salaried to the detriment of patients, predicts senior GP leader

General practice will be staffed by salaried-only doctors in the future, a senior GP leader and NHS England advisor has said.

Dr Michael Dixon, College of Medicine chair and NHS England clinical champion for social prescribing, said this comes as young doctors are increasingly avoiding taking up partnerships.

But Dr Dixon, a GP in Cullompton, Devon and the former chair of the NHS Alliance, said it is patients that will be disadvantaged when this happens.

Speaking at the Westminster Health Forum on primary care co-commissioning yesterday, Dr Dixon said: 'I think we will become salaried but I think we will lose an enormous amount... I think we will lose the dynamics... of having your doctor, your advocate, your bloke that’s there for 35 years.'

A straw poll of delegates taken earlier in his speech found that only four of around 160 delegates had a regular GP that they see, however 80% would like one.

But he said young doctors don’t want to be come partners as they can make ‘much more money by being salaried GPs’.

He said: ‘They also get headroom. They can go off and do education for half a session a week. They don’t want to be having practice meetings once a month, all night, which we do, business away days every few months and all the rest of it. They don’t want it.’

His comments come after a Pulse survey revealed that only one in five GPs thinks the partnership model will still exist in 10 years because of ongoing pressures and future liabilities on practices, including the rising cost of legal claims.

Dr Dixon added that there is currently a good balance in primary care with GPs ‘running the show’ while also being ‘shackled by contracts and performance indicators that makes sure that we do the NHS’s bidding’.

He said: ‘I turn the lights off as I leave surgery at night, make sure the roof’s not dripping and make sure that if the staff doesn’t come in in the morning I ring up someone else to do it. 

‘There’s a different ethos and I think those of you in the private industry here will probably agree with that between running your own shop and having it done for you.’

In the same speech, Dr Dixon also commented on the handover of general practice commissioning responsibilities to CCGs, commenting that it had been 'chaotic and rushed' and with a lack of 'proper support from NHS England'.

He said that this comes as half of all CCGs are now have full delegated responsibility for commissioning general practice in their areas.

Are all GPs headed for a salaried model?

A recent report from the House of Lords Committee on the Long-term Sustainability of the NHS advised the health service to explore the option of putting GPs under its 'direct employment', adding that that the 'small business model' of general practice is 'inhibiting change' that's needed to secure the sustainability of primary care.

The report quoted RCGP chair Professor Helen Stokes-Lampard as saying that 'whilst personally I love the partnership-led model of general practice, I know it is not likely to be fit for the long-term future' - comments she later clarified.

A Pulse analysis last year showed a growing trend towards partners being forced to give up their contractor status, amid underfunding of the model.

Recently, GPs at four practices in Gosport moved to salaried positions under the local trust, in an effort to shore up finances and last year, Pulse revealed that six areas in England, Scotland and Wales are planning to move towards mass salaried models

Readers' comments (12)

  • Cobblers

    If the future GPs play the passive card then I tend to agree that salaried is the way it will be. Cossted but underpaid working to someone else's agenda.

    But GP is a scarce resource. Running as self employed maybe with some support in the equivalent of 'Chambers'would be another option.

    Then you can run at your own speed under your own rules.

    It works for lawyers. It could also work for doctors.

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  • "Your bloke"

    And what about all the hardworking female Partners who have had to do all this and raise a family (as childcare wasn't as shared as it is now)

    Come on Mike- let's face the real issues. It's not that younger GPs don't want Partnership. It's the fact that no-one wants to take on this hideous contract which pays us a fixed dwindling sum of money but the demand marches on relentlessly and the hurdles get higher.

    Anyone who cares about patients and cares about job satisfaction, should be fighting tooth and nail to preserve a sustainable contract. But this will cost money in the short term.

    The tragedy is that a future of sessionals and Noctors will cost significantly more than a little bit of investment now.

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  • Vinci Ho

    '...they can make ‘much more money by being salaried GPs’.'
    It is about what you can see now but what you cannot see later.
    The fact that there are still partners working in the background with overall shortage, means salaried GPs can potentially earn more.
    When the whole system is replaced by all salaried GPs , everybody has to earn the same accordingly . What will be the price tag slapped on by the government?

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  • The whole model of General practice is going to change because of financial issues.

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  • Market forces will inexorably lead to the most efficient way of delivering care. Soft quality issues that are very hard to measure like 35 year continuity won't figure. Its no good moaning- its unstoppable.

    I suspect that this is all completely irrelevant anyway as a quantum leap in technology will make our 19th century model of medicine extinct shortly.

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  • AlanAlmond

    "policenthieves | GP Partner/Principal17 May 2017 9:24pm

    Market forces will inexorably lead to the most efficient way of delivering care. "......with the aim being to deliver the biggest profit to the person who runs the business.

    But the NHS isn't subject to genuine market forces - it's a government monopoly. If you think market forces result in cheap/efficient health care provision you only have to look at the USA to see what utter nonsense that is.

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  • General practice was once a fine body of a profession . Now it has been cruelly garrotted by lack of funds. It is already dead with ligature marks around its neck. It should be buried before it starts to attract tory privatisation flies.

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  • Oh you might be interested that Jeremy Hunt's cousin is Virginia Bottomley . She gave up her South West Surrey seat to join The British Council who bought Hotcourses from guess who? And who is MP in south west Surrey now ? Not Jeremy Hunt surely. Good old nepotism alive and well in the British Establishment.

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  • Introducing the Australian system of General Practice is a better way forward.

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  • I vote for Salried model .
    the partners have been minting and looting the NHS by delibertaely not employing partners and drawing the money .
    They employed locums by meagre pay and minting money on the pretext of unable to recruit recently , 5 years ago they employee salried GP with view to partnership ehen asked for partnership after a year they said no we dont want to add any partner .If you are not happy ,you can leave .
    Really the time has to come to put the Foot down on Partnership model and switched to uniform salaried model .

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