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A faulty production line

RCGP chair calls for all GPs to become salaried

The RCGP chair has called for a historic re-evaluation of the independent contractor model of general practices in her final address to RCGP members at the college’s conference today in Harrogate.

Professor Clare Gerada said that the time of GP practices working in isolation ‘has passed’ and called for a move towards provider organisations led by GPs to reduce fragmentation of care and reduce costs.

Professor Clare Gerada told Pulse last month that 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.

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

Professor Gerada told the conference today: ‘We have to go forward together – and it will involve grasping some nettles.

‘We will have to examine historic systems – like the independent contractor model – and ask ourselves: is this 1940s model – created as a pragmatic solution at the time – still fit for the 21st century?


‘We might also need to look at how we work together as small businesses, and ask the same question. I believe GP practices working in isolation have served their purpose well, but their time has passed.’

She said that independent practices would have to become providers of health and social care, within a ‘geographically aligned area coming together and pooling resources’.

She later told Pulse and posted on Twitter that she would support the whole profession were to become salaried and employees of the NHS.

She added that this was the direction of travel for the NHS before the ‘one of the historic misjudgement of all time’ or the Health and Social Care Act.

She said: ‘Ironically, if the coalition hadn’t imposed its unwanted and unnecessary top-down reorganisation, this move towards integration would probably have happened anyway.’

Professor Gerada highlighted figures that were released by the college today that showed general practice faces a ‘catastrophe’ after 7% drop in funds since 2010.

She also praised her successor as RCGP chair, Dr Maureen Baker, who takes over next month as a ‘formidably talented woman’.

She said: ‘We are very fortunate indeed to have her as our next chair. She knows the college inside out. She has great intelligence, determination, and courage. Our college can only flourish with Maureen at the helm.’

Readers' comments (99)

  • Sold down the river by our own leaders. A sad day.

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  • Says the CEO of Hurely Group who stands to benefit from her "21st centuary" view - yes, she would be delighted if you would give up your independant status and work for Geralda & Co.

    This woman represents herself, not the view of the members of the RCGP. Should really be ousted now, rather than being allowed to retire

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  • Gerada has repeatedly disgraced herself with the profession. I agree with her though that organisations like The Hurley group should be disbanded and she should work as a salaried Professor for 60K per year.

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  • I totally disagree, I have worked in large >10,000 patient practices and smaller practices. In my experience smaller practices by far outclass large practices on every level: quality, continuity, the level of services they provide (with phlebotomy, ecgs, spirometry etc) all done inhouse, the kindness and professionalism of their reception staff, their level of access (often walk in), the number of urgent fit in appointments they are prepared to accept, their receptiveness to be available at short notice for urgent home visits. Quality of care should be the main concern even if it is more expensive. You are wrong Claire Gerada. It may work for London where continuity is not so important but it will not work for the rest of the UK.

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  • Why on earth is continuity of care less important in London?
    nameless, faceless off the shelf standardised care is rubbish everywhere. I am fed up with London being treated as a special case. Patients in London deserve the same as elsewhere.

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  • Its time the BMA took the RCGP to task over this rubbish. There is a rotten conflict of interest here.

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  • @anonymous 2.15 I have been Practice Manager in large and small London Practices and can say continuity is very important. As one inner London Twitter GP says this going to like only being able to buy coffee from Starbucks.

    It will lead to huge data grabs to support these so called services so could signal the end of doc/patient confidentiality.

    In Bucks we have a super Surgery a bit like Clare's set up hoovering up small practices and zero GP choice so in our latest Parish Magazine our local Private GP Service is advertising. Privatisation by the backdoor?

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  • Let's suppose you have 5 single practices each with 2 full time GPs with a practice list of 3000 patients per practice.These practices then become super federated into one large practice which has now 15,000 patients served by 10 GPs.What changes?How does continuity of care improve?I don't even see where the cost savings are going to come from unless you merge all the practices (at the expense of longer travelling distances for patients and doctors) into one single building and reduce the non medical expenses.Can someone explain to me the logic of super-federated practices?

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  • The idea is that " back office" functions are shared to save money. One practice manager, one central phone call centre to make appointments, shared admin etc. Also to have nurses shared between practices so they can cover each other for holidays etc. OR... bad practices that lose the best staff can leach off the good practices which treat their staff well.....

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  • ....and how does that improve care from the patient's point of view?

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