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Gold, incentives and meh

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)

  • Azeem Majeed | GP Partner | 03 March 2015 11:38am

    I really respect your posts but want to add a lot of salaried docs like myself are employed by private companies - it's not what i really want to do but i wouldn't touch a partnership with a barge pole. what i want is my own independent practice with a decent legally binding contract - until then i have to make do. Whether you are salaried to the state or to a private company you will still be a slave to the system with the emphasis on micro-management, guidelines and tick box performance targets which are not necessarily evidence based, logical or make any financial sense. It is about 'fitting in', not making waves, keeping your manager happy (and your 'clients') and covering your back. We are better being free than slaves to a system. I'm just waiting for the system to hopefully collapse but as a Salaried/locum doctor i don't advocate salaried posts as a career choice. It's a choice of convenience or making-do.

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  • Anonymous | GP Partner | 03 March 2015 1:50pm

    Can not believe you have said the name of (s)he who shall not be named. Now all protective spells and enchantments are broken and the death eaters or snatchers will appear to your current position.

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  • 1.50pm amd 2.45pm.....don.t worry G is very resilient

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  • GP Crisis ! Nobody wants to be a GP, at least one reporter is brave enough ...........enjoy this BBC clips.... only 15 minutes summarise it all
    http://www.bbc.co.uk/iplayer/episode/b053hfmv/inside-out-east-midlands-02032015

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  • Azeem Majeed | GP Partner | 03 March 2015 11:38am

    Azeem, you write a lot of sensible posts but I've seen your shameless campaigning in other newspaper forums about a salaried workforce.

    I think your views actually denigrate the profession and I think they are frankly bad for the NHS as well. Partnerships are incredibly cost effective and gives the profession a real stake in improving healthcare locally, incentivising efficiency.

    There is absolutely no reason partnerships can't work. It isn't a broken system, just an extremely underfunded one.

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  • I do not agree to the statement in the above article that young GP's are shunning partnerships. The fact of the matter is there are not enough partnership jobs being advertised by the existing surgeries. Even if they do advertise the partnership jobs, the terms and conditions for the partnership jobs are not usually good.

    The Government should allow the young GPs to open their own surgeries without having to join existing practices and by doing so the patients will be benefited by improved access, continuity of care and also better quality care.

    The existing partners, being owners of their business should ideally and ethically be doing more clinical sessions to provide the continuity of care to their registered patients, but sadly, many of them work part-time (right word is SEMI-RETIRED) and thereby compromising the continuity of care which they claim to be providing.

    Either there should be a system where all GP's are salaried or any GP's should be given a chance to open their own surgeries.

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  • I'm sorry but I'm not sure which century the above poster is commenting on. Locally, many surgeries are struggling to recruit partners. We advertised a couple of years ago, had much less applicants then we did 6 years ago when another partner retired. And the candidate we had declined the partnership when he realized he hardly earns more then his current salaried post.

    Ok, we are in a deprived area of industrial city but what do you expect? Nicer location and nicer job will be harder to get, that's fact of the world!

    I think disillusioned salaried GPs really need to start opening their eyes and look around rather then moaning on posts like this.

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  • Azeem Majeed,

    Terms and conditions, salary scale paid by private providers APMS contracts are actually a lot better than being a salaried GP in a GP practice. Secondly working as a salaried GP in a GP practice is not working under NHS because the salary, work conditions are controlled by partners, and there is no element of HR , so the post is unprotected. The BMA will say it cannot interfere with what the practice does.

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  • Nothing wrong with mentioning my name - its the terrible usually anonymous abuse that i get on this site that i find hard to bear. I don't expect everyone to agree with me - of course not. But I do object to unkindness, especially amongst my own profession. I work hard for general practice - and continue to do so day in day out. Like many on this site I worry about whats happening to us. I worry about the flight to Federations - not sure where all of that is going to end. I worry that we are being turned into 'chronic disease managers' when I am a generalist of all ages. I worry about our exhaustion and that many are to frightened to speak out. I worry about the 400% increase to my sick doctor service. We must make sure we support each other - as its tough for us all.

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  • While I do not agree with all Dr Gerada's views re salaried v partners based service, I completely agree that anonymous abuse is unacceptable. Many of us are struggling under current conditions and we need to consider all options. I am also grateful to my colleagues, of which Dr Gerada is one, who are highlighting the strain we are under.

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