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The waiting game

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)

  • No Pre-determined outcome there then ...

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  • >we need to get rid of the independent contractor status.

    No she wouldn't want that. Her practice model of a few partners running a large number of salaried GPs works perfectly to her satisfaction......................!

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  • thanks Anonymous 11.56pm

    I wondered how long it would be before someone claimed I had a conflict of interest - and that this was determining my thinking and views! How would i be better off if we didn't have partnerships? I don't know - what I know is that I am committed to general practice - I love the profession and believe it too be the back bone of any health service. I want to improve and protect my profession so that we can improve the care we provide to patients - and I believe the ICS has done its time. (PS I wrote about this in 2009 way before my own practice had expanded)

    I use my own practice as a barometer of what is going on - and can categorically say I have never suggested anything, at any time, merely because I would personally gain.


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  • From my point of view organisations where the buck stops with a clinician seem to provide better quality to patients and more efficiency to the NHS than organisations where the buck stops with a manager, large NHS organisation or large private company.
    GP V OOH. Mental health V Medical Admissions. Old DNs V Serco DNs etc

    I can't really imagine things working with every GP working 4 hour BMA sessions as an employee/ not putting their own time into QOF/ reports for admission prevention etc.

    This is only anecdotal though, so would like to hear what other people think. It would be more likely to work if there were enough GPs around to make reasonable competition for employment opportunities, but outside London that is just not the case.

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  • Vinci Ho

    ' I have never claimed to have a monopoly of wisdom but one thing I've learned from this job is you should always try to do the right thing,not the easy thing. Let the day to day judgements come and go , be prepared to be JUDGED BY HISTORY.'
    Question is what is the 'right' thing? What is the 'easy' thing?
    Who said this? Tony Blair on Iraq War 2003......

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  • Perhaps it is better to be salaried - with leave and health and safety. The independent status [IS] means imposed contracts,escalating workloads with no means of escape, depression and burn out. Witness the exodus from the IS, through retirement and OZ. Salaried means health and safety sick, annual and study! leave. I think having worked in the NHS for almost 40 years it is time to leave IS. I think structured time, even though more regulated might save us from burn out.

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  • Are we really "independent" contractors?

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  • I do think Clare realises what is good for London may not fit the rest of the country which is why Berkshire where I practice had good OOH care pre2004 and post. 111 has caused chaos at our A+E whilst the OOH call volume has decreased. Where GPs were talking and looking after patient 111 has sent them to less qualified staff in A+E -genius.
    I'm ready to give up responsibility for my building staff and getting the job done and demanding pay, rest, study leave, annual leave and not crawling in whilst sick as no one else can cover my on call.
    Let them win over our complacent alive bodies. Take up clinical jobs only.----unfortunately we know it'll cost more.

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  • Vinci Ho

    So everybody goes salaried , that will be happy days???
    If a government does not really care and want to play radical and ruthless , you really think it would not be able to find a way to impose on us???

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  • Practice size and clinical targets are currently money driven. Salaried service would be management driven. If population and targets and GP numbers remain the same, this could only be tackled with more GPs on lower pay or shorter appointments times...

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