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London should consider developing GP 'salaried service', finds report

London should consider developing a ‘salaried service’ for general practice because of the high numbers of young GPs shunning partner positions, a report by the London Assembly’s health committee has recommended.

The report, set up by London’s governing body and chaired by Labour MP and GP Dr Onkar Sahota, makes five recommendations, including that NHS England (London) investigates the reasons for low GP morale, develops new alternative practice models, boosts GP numbers and invests in new premises.

It also says that there was ‘a case’ that a salaried service would ‘extend the provision of services’.

The report estimates that around 16,000 more GPs will be needed nationally than are currently available by 2021, and that almost 16% of London GPs are over 60 years old.

It warns that ‘if large numbers of GPs take early retirement, London could be desperately short of doctors,’ and follows a survey yesterday that found that more than half of GPs are considering early retirement.

The recommendation that London takes on a salaried service follows a declaration by NHS Hull CCG that they are looking at a ‘wholly salaried model’, and comes at a time when NHS England is looking to devolve responsibility to localities either through co-commissioning or even giving Greater Manchester councils and CCGs full responsibilities for the NHS and social care budget.

The London report analyses the pressures that general practice is under and suggesting strategies for boosting services at a time of scarce resource and rapidly expanding patient numbers.

In a section on workforce challenges, the report references seven Pulse stories highlighting issues such as high vacancy rates and that young doctors are increasingly opting for salaried or locum positions.

It also references the story from last year that about 4,700 doctors a year applying for certificates that would enable them to work overseas.

On the issue of salaried GPs the report states: ‘There is a case for NHS England (London) to consider developing a salaried GP service in London to extend the provision of service where needed, and to facilitate a career choice which newly qualified GPs are increasingly making.

‘The workforce in general practice has seen a noticeable shift towards increasing numbers of salaried GPs since the turn of the century. There was a 12-fold increase in salaried GPs nationally between 2010 and 2025. Practices also experienced increases in locum fees over the same period, averaging 9.5% in 2012. The rise in locum positions has implications for care continuity and quality, and for the long term stability of GP care provision.’

It adds: ‘Anecdotal evidence suggests a growing reluctance to take on the liability of owning a practice, employing the staff and the extra work that comes with being an employer, along with the workload demands. Young doctors are opting for salaried or locum positions.

Dr Sahota said: ‘As many as 90% of all the consultations in the NHS are through GPs – our family doctors we know and trust. Yet in London we are seeing cracks and fractures which, if left unattended, could have disastrous results for patients and doctors.’

Readers' comments (31)

  • So you think that young GPs will come in their droves to work as salaried in a new huge London Assembly controlled Primary Care Organisation....dream on.....certainly not while GPs can have more control over their lives working as locums with more money in their pockets....GPs are currently shunning salaried GP positions....what will make this change?

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  • This is about taking control further and further away from those who will actually be delivering care.

    I believe overwhelmingly that GPs want autonomy and a say in their professional lives. The whole problem with the uk system is that newly qualified doctors have to work within the existing infrastructure which is controlled by powers much more senior.

    It's looking as though, in the future, if you want to call your own shots there will only be 2 viable options- to either locus or emigrate! As partnerships will be made unviable or obsolete.

    If you were a young 20's/30s something newbie GP offered a salaried job on £60k or a Aussie job for £160k which one would you choose??????????????

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  • Above should read *locum

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  • @ 4.04 am

    i am sure you are right. however, there is no profession where newly qualified people in their 20s have the same authority and power as those who have been doing the job for years, put in the graft and built up their business and reputation.

    newly qualified gps need support and guidance, provided by their seniors, as in any other profession.

    Already in general practice new GPs reach the same financial level within 3 years and after that there is no pay increase except seniority which is being phased out.

    i find it incredible that new Gps seriously seem to think that they are entitled to be treated entirely equally to a GP with 30 years experience, who may be a GP trainer or lecturer. Any salaried service will reflect experience more than the current system.

    Having said this, there are some partners which exploit juniors and they should be shunned. let them be the first to be unable to recruit!

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  • Mass delusional state,quite funny and at the same time very sad.Its all about the T&Cs,in partnereships+salaried posts at the moment these are extremeley poor that is why there is a crisis,correct this and recruitment will improve,if you dont they will be dissapointed with a poor response.If they think they will replace GPs with noctors have you even tried to recruit a practice nurse recently.GP land is in the beginings of its death roll the poltitician are too stupid or too callous to recognise this.best wishes all.

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  • Vinci Ho

    It is a Londonian issue from day 1. Although I am all for our younger colleagues to decide what they want for their future, one word has been sticking up amongst their opinions(after talking to them) -- Independence.
    I certainly don't think NHSE wants to include this word in their plan.

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  • Are you surprised? Certain ex-RCGP chair who's excusective on a large primary care chain with vision to have a salaried system is on London's NHS primary care board.

    No conflict of interest there then!

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  • 8:15: name the person please. Especially if you are 'Anonymous' you have nothing to lose and we might learn something. Thanks

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  • I CAN TELL YOU A MAJOR CAUSE OF LOW MORALE......THE BLOODY DAILY MAIL....EVERY DAY I HOPE THAT THIS "NASTY RAG" GOES INTO LIQUIDATION

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  • PS. The GMS contract requires practices to use the BMA model contract which includes yearly increments.

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