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Gerada to 'start dialogue' on GPs' independent contractor status in new NHS England role

Professor Clare Gerada’s new role at NHS England will see her tackle a range of ‘thorny’ issues - including the controversial question of whether GPs should retain their independent contractor status - the RCGP chair has told Pulse.

In an exclusive interview just days after her appointment was announced, Professor Gerada outlined some of her goals as the new clinical chair for primary care transformation in London - a paid, one-day-a-week position she will take on when she steps down as college chair in November.

She said she wanted to discuss how to best deliver integrated care, which will include her ideas for integrated care co-operatives, groups formed of primary, secondary and community care clinicans.

This could also involve examining GPs’ independent contractor status, she added, and moving away from the health service that was designed in the post-war years.

She said: ‘My priority for my first year is around talking to the profession about how we can best deliver services that are in the best interests of our patients and keeping the best elements of general practice – first contact care, GPs’ fingers on the patients’ pulse.’

Professor Gerada said integration was the best way of delivering services in the patient’s best interests and she wanted to start a ‘dialogue’ about how integration should look.

Her own preferred model for integration is ‘integrated care co-operatives’, a concept she explained at an RCGP event on federations last week, which would ‘bring together all relevant health care providers - within a contiguous and geographically bound authority area - as not-for-profit organisations with resources allocated and distributed according to the best needs of the population’.

However, in order to achieve this, ‘it may be that we have to look at some thorny issues’, she added. ‘We may have to examine the independent contractor status and decide what the pros and the cons of it are.’

She added: ‘I am not coming into my new job saying we need to get rid of the independent contractor status – I’m categorically not saying that. I am just saying let’s start to discuss these things and see where it takes us.’

The integrated care co-operatives would not necessarily mean GPs giving up their independent contractor status, she said, but they would make it ‘harder - and I am not 100% sure what the advantages are, although that’s not to say there aren’t advantages’.

Professor Gerada, who has been chair of the RCGP since November 2010, will also take forward NHS England’s ‘call to action’ on reforming GP services as part of her new job.


Readers' comments (29)

  • Thanks anonymous 10:52! Nicely analysed. Why are the governments itching to get rid of the traditional general practice?

    If we answer this question, we would find out if its for the best interest of the public or for the benefit of the 'private sector managers'.

    In traditional general practice, which I dare say is unique in the whole world, the GPs manage care; in the new model(s), we would be managed by the 'private sector' and hence the politicians in the background. It's a struggle for power over management.

    What will happen to the patients? People must take responsibility of their own health like in the US, and must buy sufficient insurance. The 'post-war' "socialistic" NHS system to provide free care for everyone (and obviously too expensive for any government), must be erased from the page of history anyway ... It's just the scenario that has been put together by all the leading parties in the UK. Very clever, no party is to be blamed by people, hence losing votes, but in fact it's the GPs to be blamed because they have failed to provide care in the same way they have done all these years. A good question to ask is "why now? Why us?"

    I have no criticism to Dr Gerada's views; I just think she needs to have a look around the different healthcare systems around the world to have a better idea of the route she is taking. There are plenty of examples of the system she is trying to design, it's not unique and not innovative. Integrated care after all is going to be managed by 'Family Doctors' who wouldn't be GPs in the sense they are now, ie with management skills and sufficient clinical and upfront involvement.

    Please Clare, wake up and see we are losing our heritage of 'post-war NHS'; it's not just a reform, but is a termination of a fair system of health provision for all, though not really free, but at least free at the point of delivery. And that is what makes a difference!

    I wouldn't accuse Clare, as a respectful colleague of mine, of being politically driven or of having interest in any of the suggested changes, but I shall urge her to think twice before allowing the politicians to picture a Eutopia for her and leave her alone with her vision, half way alone.

    God bless you all and God bless America!

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  • A salaried service, the road to serfdom.

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  • I have no doubt that Comrade Clare's Soviet ideals will deliver us to be property of the state ... Apart, of course, from GP Mandarins like herself who will reinforce their position within the oligarchy. Live long and prosper!

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  • Having started to work with nhs England and our local ccg I have finally realised that you will never find that one person that understands what and how things need to change. Most nhs England bods are so detached from primary care it's a joke

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  • They could not afford to make us salaried as they would have to buy our properties that house the surgeries or take over the responsibility of our leases.

    I think the plan is to make our surgeries non viable, destabilise us, leave us with the debts taken out in good faith, and allow big business to set up a huge super surgery in each town. No choice for patients.

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  • 9.14 -They won't be paying for it. Buildings will be bought and you will sell because the contract and pay will make it impossible to continue with Health Corp opening on Sundays near you and cherry picking your 'valuable' patients. The ones remaining loyal to you will be the ones who actually know how good you are because they see you regularly but cost you so much. They won't take residential homes nursing homes on either. You cannot believe that the protection of property and goodwill from patients will save you. The public who need us lose out, the public that shout loudest about being busy and NEED evening and weekend appointments won't care until they age get chronically ill and Health Corp will have gone through another reorganisation and dump them or raise their costs too high.

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  • Salaried is really what we are. To me that is an imposed contract.
    Salaried maybe not attractive but it has health and safety, regulated hours worked and patients seen in a day. The EU sees to that. The silver tsunami of multimorbidity and dementia means we will have plenty of work. The world is short of doctors. Really. If we stood up to the Govt. they would have no where to go. The nation needs its doctors.

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  • I'm not sure how much employee protection GPs will have even if General Practice becomes a salaried service.
    I don't remember overly much employment protection when I was a hossy doc.
    Clearly the EWTD has come in since then but you can 'voluntarily' opt out of that. I can imagine a scenario where there is a wholesale 'voluntary' opt out in order to maintain a reasonable income in the private sector.
    If only doctors would recognise their power as a collective and act like one.
    COI Retired

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  • all interesting conversations. What people seem to neglect is what is happening in response to restrictions imposed by there various interested parties. The locum rates are going through the roof. 27% of matriculating GP's are out right leaving the NHS... and locum doctors. choosing their own hours, have not administrative role, are making more money then partners without the headache of being one. This will quickly leave the NHS high and dry for regular working doctors, and no incentive for anyone to even bother aspiring to be a partner. If everyone goes salaried, and make the lousy 110k or less. would you choose £100 an hour locum job or your trust job for about 40£ an hour... in the end it comes down to chickens and your families...

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