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A faulty production line

GPs should lose independent contractor status, suggests leading GP academic

GPs should give up their independent contractor status and become NHS employees, an influential GP academic has suggested.

Professor Azeem Majeed, head of the Department of Primary Care & Public Health at Imperial College London and a part-time GP in South London, also said that primary care should drop capitation-based funding in favour of methods that link workload more closely to funding.

The leading academic’s suggestion - in an editorial published in the Journal of the Royal Society of Medicine titled ‘General practice in the United Kingdom: meeting the
challenges of the early 21st century’
- comes after Professor Clare Gerada, outgoing RCGP chair, said she would be examining GPs giving up independent contractor status in her new role as clinical chair for primary care transformation in London with NHS England.

In his article, Professor Majeed said: ‘Under the current capitation-based funding method, GPs face unrestricted demands for their services and on their time while having to operate on a fixed budget.’

This increases their workload, he added, and increases pressure on other parts of the NHS, such as emergency departments.

He said: ‘Although capitation-based budgets have been the cornerstone of UK general practice for many decades, it may be time to consider modifying this method of funding primary care in favour of methods that link workload more closely to funding.’

However, his most ‘radical’ step was to question GPs’ independent contractor status.

He said: ‘An even more radical step would be for general practitioners to give up their independent contractor status and become NHS employees under similar employment terms to those offered to doctors working in acute, community and mental health trusts. This could potentially allow general practitioners and their staff to be employed on national NHS terms of service and overcome the divide that is being created between self-employed general practice principals and salaried general practitioners.’

Other options considered by Professor Majeed include the incorporation of tariff-based methods of funding in place of or in addition to capitation payments, the establishment of ‘super-partnerships’ involving the merger of general practices and greater collaboration between practices via the formation of networks or federations.

Professor Gerada told Pulse earlier this month ‘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.’

Readers' comments (65)

  • GP academic - ie. someone who doesn't see patients much. Move on ladies and gentleman, nothing to see here...

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  • last nail in the coffin, before privatisation takes over. make way for the politicians agenda of privatising NHS in a roundabout way, using such absurd logic.

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  • Speaking as GP principal, 3500 patients, many elderly with high morbidity, difficult to recruit -- I would jump at a salaried contract if it was on the BMA model contract, and somebody else assumed responsibility for staff, IT, premises, qof, qip, referral targets, prescribing targets, CCG meetings,LES's,DES's , patient surveys, patient liaison group, all private reporting work (presumably DLA reports etc would be remuneration on top of agreed salary?).

    Sorry, just woke up, was having a dream there for a moment.........

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  • Vinci Ho

    Yes , ideologically sound . In fact , many might think this could be the 'same' salary with no administration.
    In reality? This gives politicians the chance(whatever party ) to 'substantially' cut the income/salary of GPs as they become employees. Then the number of hours and patients you will have to see everyday also goes up substantially . If you need more 'help' , you are on your own , mate.
    Single handed GPs RIP, ask your patients how they would feel going into a federation GP practice .....

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  • HMG know that they couldn't do this. I'm not particularly bothered - I'd be an employee with sick leave, holiday pay etc. I'd also be bound by the European Working Time Directive. And they can shove the management aspects of the surgery where the sun don't shine.

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  • Quite agree with all of above. I write this whilst on holiday in Greece having checked and responded to practice meeting agenda done this am in my absence but still needing my input as a partner in charge of looking at finance.

    I won't be doing that as an employee I tell ya.....

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  • We have never been "independent" contractors.

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  • As a newly qualified GP still trying to grasp the clinical aspects of the job, and with NO formal training in the administrative/managerial side of things, this sounds fairly tempting. But whatever is decided in the end I feel like none of us will have a choice. I'll be going to Australia 2014 anyway, g'day mate!

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  • Get rid of capitation, GP prinicipals and pay us for activity only?

    That's one way to cripple the NHS and bring in privatisation

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  • Unblock toilets, remove dead pigeon from drain pipe, replace damp proof membrane when damp appeared in consulting rooms, cajole staff to stay, pay redundancy, subsidise maternity leave, attend surgery in middle of night when burglar alarm goes off, attend surgery in the middle of the night when fire alarm goes off, deal with weeping receptionists, replace practice manager, change light bulbs, maintain building, be prepared at 48 hours notice for CQC jeopardy, worry continuously, cover for partners ill health, and as a result when ill struggle on when no-one else would in any othe area of the NHS..... I"m sure most GPs could massively extend this list. If the government really thinks that they can take all this on more cost effectively by making us all salaried then I will spend the first six months of my early retirement falling about laughing.

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