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GPs go forth

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)

  • Bob Hodges

    Given the frequency of 'massive top-down reogansiations of the NHS', I still reckon GP Partnerships have got a better chance of surviving the next 10 years than NHS England.

    The irony is obviously lost on Dr Berwick.

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  • But in the absence of doctors willing to work the hours I have worked or at the rate I have worked ( quite sensibly I must add) the economic difference will be less and even a full time doctor is now only available for 50 hours of a 168 hour week we can't really claim amazing continuity....

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  • 11.49 The reason doctors are 'only' available for 50h continuous care a week is because we are now obliged to do huge tranches of work most of which is not real, hands-on medicine: QOF, appraisal forms, LES, DES, CQC, CCG, PPG, PSQ, unnecessary audits, - I could go on. Full-time doctors are literally drowning in paperwork and have to put in many more that officially recognised hours just to keep their careers.

    All this stuff dreamed up mainly by non-doctors comes at enormous expense to the tax paying public but there is no recognition of the damage it does to real patient care. You can hardly blame GPs for looking for a way out, this is entirely rational since we all have our own lives to lead as well.

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  • Dr Smith:
    Adequate continuity is not about being available a full week of 168 hours, as you should know. It is about ensuring there are enough resources available to manage patients, and allow those with ongoing medical issues to see a regular clinician. That means weeding out the minor illnesses to self-care, Pharmacy etc, or minor illness nurses.
    Continuity is an aspiration nowadays, because the public only care about what they can get free of charge, what they WANT, and not care about society as a, me, me. The suggestion that they should only be allowed to have what is needed ends in outcries and needless complaints.
    Aspects of what we do can be done by others, at lower salaries, but as already suggested in posts, they don't take the responsibility, and their experience and remit remains limited, in comparison. Often, they have recourse to GPs for back-up.

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  • Ivan Benett

    I agree, the days of sustainable independent contractor status are over. Might as well get used to it and wind down you capital account. The public will not support such variability in service provision as is the case at present, or resistance to change. Dr Findlay died a long time ago, and what follwed him is also dying. The public will want an out-of-hospital system that is public facing, that is responsive to their perceived needs, and integrated with other health and care services
    But, we will always need GPs, however organised and employed. So smell the coffee GPC, RCGP and partners. The pace of change is acceleration not slowing. Stop the populist rhetoric we read in these columns. Face the reality.
    I know some reading this column will get angry, bluster or be rude. Some will call for a strike or resignation, and other will imaging the grass is greener in Australia (it isn't, it's dry and brown).
    You can take out all your frustrations in these columns, but it wont change the truth.

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  • Ivan,

    I'm afraid the truth you speak off is manufactured by those in the power. And I count you amongst them from your work and your previous posts.

    I still believe partnership model can be saved and it will serve as a better health care model but only if the medical profession unite together. Sadly Ivan is right in pointing out it's as good as gone as you can see from the article, we have been betrayed by those the power.

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  • I disagree with the opinion expressed above but I am prepared to put it to the test. Ask patients what they want (including the silent majority rather than just listening to the vociferous minority) and spell out the practical options - local surgery, continuity of care and normal opening times v distant surgery, any time but no continuity. Should a fully-informed public choose the latter, it'd be interesting to see what happens to GP recruitment.

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  • I mean the opinion above the one above now (Ivan Benett)

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  • Peter Swinyard has raised the point that we could probably fund sustainable care for patients if we charged £150 per head.
    ...My calculations would put it nearer £200 per patient. If you take current expenditure on staff and consumables at 60% of gross practice income and a list of 2000 per whole time partner this would work.

    Even if expenses rose to 70% a figure of £200 per patient per year would provide some buffering for practices.

    I think these are real sums that could work if the issue of patients accessing NHS prescription subsidies was sorted out.

    In answer to your question Peter I think your proposal could work... it is high time that documented proposals for private practice were put forward to the profession. If only we had a functional union... sadly we only have the BMA!

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  • 4:10 £200/head sounds about right - that's about the same price as replacing a set of car tyres or a replacement mobile phone so is probably affordable to most of the population. This is a debate that needs to be had and not suppressed by the BMA.

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