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The waiting game

GP partnerships will be gone in ten years, says NHS England official

GPs’ independent contractor status will be ‘probably be gone’ within ten years, NHS England’s deputy medical director Dr Mike Bewick has claimed.

Speaking at the Westminster Health Forum conference in London yesterday, Dr Bewick said that the current organisational structure of primary care is no longer ‘sustainable’ or ‘desirable’, partly due to the ongoing GP recruitment crisis.

He added that he expects new provider organisations to develop within a decade because the current model will not serve the patients’ needs, adding that the difficulties of recruiting GP partnerships will consequently mean that ‘we’ll have to think of something different’.

Dr Bewick told delegates: ‘The current organisational structure of primary care is no longer sustainable or, increasingly, desirable. I am going to say just two things that I think are going to be true: one is that in 10 years’ time the term independent contractor will be anachronistic and probably it will be gone. And the second is that we won’t talk about primary care, we will talk about out-of-hospital provision and out-of-hospital providers.’

He also said that he expects each new provider model to accommodate around 300,000 patients - similiar to CCGs

‘In primary care at the moment, more than 50% of doctors are salaried,’ he said. ‘There will be a force majeure that will move away from a partnership type organisation because it will not serve them and equally when you can’t recruit to partnerships, it will mean we’ll have to think of something different.’

However, despite proposing a move to larger primary care organisations, Dr Bewick said that this would not be at the expense of local healthcare services.

‘I don’t think we should confuse that with not delivering healthcare by people you know in your locality. Localism is in my blood.  

‘We should be forming organisational mergers with either community trusts or secondary care, or with other providers from other sectors. Providing they have the values of the NHS at their heart, I am not too worried about who delivers but more how it’s delivered and the outcomes for patients.’

Professor Clare Gerada last year said that all GPs should become salaried in her last speech as chair of the RCGP, comments that her successor Dr Maureen Baker rebuked shortly after taking office,



Readers' comments (69)

  • Their plan is to replace the GP with nurses,HCAs and algorithms. So the remaining GPs will be given a list size of 4,000 +

    They think it will work. We know different.

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  • "...the difficulties of recruiting GP partnerships will consequently mean that ‘we’ll have to think of something different’..."

    No, it doesn't. Instead one could think about why there are suddenly difficulties recruiting to a previously popular profession (both with doctors and patients) and take action accordingly. Better that than deliberately making something intolerable and then "having" to think of an alternative

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  • This has always been the plan.

    Nicholson hinted at 'getting rid' of cornershop mentality, labour talked about reviewing independent contractor status, RCGP backed move to salaried work force. At least Mike Bewick has been direct about it BUT it is a recruitment crisis of their own making. It's amazing that GPs are basically being blamed for the recruitment crisis as well !

    There has been a clear strategy of;

    1. dumping as much as possible on GPs targetting partners in particular
    2. pushing partners to retire, quit, emigrate or sell up
    3. for those that want to serve their patients a list of never ending politically motivated and non-evidence based check lists are made which generates frustration and confusion forcing those GPs into early retirement.
    4. those practices that fold are going to be converted to temporary contracts thereby locking those lists from independent GPs.

    i suspect once all independent contracts are converted to temp contracts they (NHSE) will go after locums and salaried drs and set targets for them - if they don't comply they will not be hired or effectively blacklisted.

    within a few years we will all be salaried working for large corporations as it is 'desirable'. some may say a 'certain person' is a sell out as he would be happy for us to work for Virgin but not for ourselves. I won't say it though as i need to work for another 25 years.

    no point asking for a vote as we can rely on gpc, bma to look puzzled, raise thir hands up and put a motion on possibly saying something but backing down as they don't want to rock the boat as for alternative models - it's too late.

    RIP general practice - a once noble and respected profession :(

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  • There is so much to write about this article, I don't even know where to start.

    Yes - the sustainability and workforce issues are entirely down to successive governments, with their poor workforce planning, micro-management and exponential piling of on more work which is poorly defined in our contracts. Sadly, we have neither the leadership or representation to reverse any of this.

    The reality is glaringly obvious to me; NHSE have no interest in a quality service. If they think they can manage primary care health needs with a conveyer belt style of a few nurses at one end, a few physician's assistants at the other and a salaried GP in the middle, then they may also be able to turn wine into water.

    The knock on effect on secondary care will be quite spectacular with this model. Admissions, referrals, investigations....they will all sky rocket. Defensive medicine will become an even bigger monster and I dread to think who will be paying for this.

    GP Partners are a bit like stay at home parents; working endlessly, no terms and conditions and having round the clock responsibility. It's only when the parents go back to work, you realise how expensive child care is.

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  • The whole government agenda all along has been to enact a wholesale constructive dismissal of the entire profession:you make things so difficult that GPs have no choice but to leave.On the other hand there is a part of me,and perhaps this is my disillusionment speaking,that feels that doctors would be better served working in hospitals where the truly sick patients are.Most of the crud we see in GP land can be done by other professionals and dealing with crap has meant that we have become deskilled and lost respect with joe public.

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  • He did not say he wants rid of the profession. GPs will still exist just not the independent contractor model

    A bit of realistic introspection might be useful. It's no longer credible to credit all the positive things about primary to GPs and blame all the failings on others.

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  • 8:09

    Easy for you to say that but they are proposing to leave GP partners with huge liabilities while they move on to a new system.

    Do you think it is fair that a GP lose his house and life savings, simply because the DOH has decided they want another system ?

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  • Waits will grow, personal relationship with a GP will deteriorate.

    Sounds like a perfect recipe for more private GPs in future. Some patients will pay for this.

    Sound like dentistry in the UK?

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  • It doesn't have to be like this. If we stop fighting amongst ourselves it would be relatively straightforward to pull the plug on the NHS and move to an affordable Denplan like system. European co-payment systems deliver far better outcomes and they continue to look after their poor.

    We are actually quite a powerful lobby group if we stand united. The patients are far more likely to trust us than the usual ragbag of government contractors. However, if we allow the government to sell us to the private sector via the back door, costs to the taxpayer will rise massively because the HMOs require so much extra infrastructure.

    Fancy algorithms and practitioners will never be capable of managing medical risk and complexity which will be passed on to hospitals at greater cost. If this model was so great it would have been used extensively elsewhere but it's not. For many cultural and historic reasons, the doctor brand is way too strong for the public to trust anyone else with their healthcare.

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  • 'Dr Bewick told delegates: ‘The current organisational structure of primary care is no longer sustainable or, increasingly, desirable'

    I agree - The disastrous organisational chaos of NHS England and CCGs while destroying the few good parts of PCTs, with the consistent cuts in quality and funding have left things in a dire state.

    There is an epidemic of Ivory Tower former GPs and doctors who are destroying the NHS - and leading the path towards Private US style healthcare giants taking over Primary care for the profit of the lobbyists and politician who will end their careers with those turn coat GPs/doctors as directors on the boards of these companies.

    I predicted the move to privatisation back in 2004 and was dismissed by the GP leadership, and told it was overreaction, my the same people who believed and sold MPIG as guaranteed in perpetuity.

    Watch the Rats jump ship - just a sad prediction that will be ignored by the BMA and our representatives until its too late.

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