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General practice should move towards becoming predominantly salaried, says Burnham

Exclusive General practice should become a predominantly salaried profession, with GPs working as employees of large health and social care organisations, shadow health secretary Andy Burnham has told Pulse.

In an exclusive interview, Mr Burnham said the salaried model would be more financially sustainable, helping to ‘unlock’ funding ‘tied up in hospital’ and also help GPs cope better with patient demands.

Having previously indicated that GPs’ independent contractor status could be reviewed under Labour, these comments are the strongest indication that the party wants to move to a model of integrated care organisations that employ GPs, rather than GP partnerships.

Under the plans, which Mr Burnham said mirrored visions presented by the Royal College of Physicians’ Future Hospital Commission, GPs would ‘not be loyal to primary care or to the hospital but to the local population’.

Mr Burnham said: ‘I think that is the way we need to start thinking and be open to the idea that that might mean a GP working as a salaried employee of an integrated care organisation.’

Initially when asked whether his vision meant GPs would no longer be independent contractors, Mr Burnham said: ‘Not necessarily. I mean they could be.’

However, he later added: ‘I do actually see a role for more salaried GPs… outside of those contractual models. I think younger people might be more attracted to salaried employment.

‘I can very much envisage a future where we have more integrated care organisations that employ GPs, and the GPs will sit at the centre of teams that are multidisciplinary. They may be the decision maker if you like, or the kind of ultimately accountable person operating this different model of care.’

Mr Burnham also said that working within these organisations is how Labour envisages that GPs will be able to fulful its promises for patients to be able to access a GP appointment within 48 hours.

He said: ‘What I am saying is it is not just the GP sitting there and working through it. It is about the GP saying: “look if you need bereavement counselling I am going to get it for you today, because we have a structured person, provider, organisation that does this”. Or if it is relationship advice, benefits advice, IAPT or whatever it might be.

‘[Within the model] those non-medical interventions can be drawn down as quickly as it can be to give people a bit of paper to get some medication. I think that is about empowering the profession to really deal with people’s problems and help them regain control of their lives rather than just managing the symptoms of people’s lives.’

Mr Burnham also said he thinks this would help attract new recruits to general practice by ‘painting a picture’ to graduates of a profession where ‘people’s horizons are not quite as limited’ and where you don’t have to ‘take on commitments at a local level, the practice, almost commit your career to one area’.

However, deputy GPC chair Dr Richard Vautrey criticised the plans.

He said: ‘I think if his plan is to actually increase the number of salaried GPs that means large numbers will look at general practice and say it is not for them. They want all that comes with being an independent contractor. Many would aspire to be independent contractors even if they initially wanted to become salaried GPs.

‘I don’t think that the idea that just having lots of salaried GPs will solve the problem. If we want to encourage doctors to choose general practice then we have to maintain and offer the range of models for doctors to work with.’

Former chair of the RCGP Professor Clare Gerada caused controversy last year with her suggestion that GPs should relinquish their independent contractor status. GPs reacted overwhelmingly against the suggestion and a Pulse survey showed more than three-quarters to be against such a move.

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

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  • Andy Burnham MP 2014

Readers' comments (81)

  • Jealousy of GP partners status and pay driven the Persecution and of Partners under all Political umbre4lla for the last 10yrs.

    Any vote for a politician - same Sh@t different day.

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  • Enforcing employed status allows better control of costs, driving down incomes/salaries as non-acceptance would result in not renewing contracts!
    I won't be in the UK hopefully this time next year! My income dropped significantly as a partner, to the point it is hardly worth my while continuing. Better options to give me and my family the life we deserve after years of hard work and academic and commercial achievement!

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  • Dream on with the model...no party can deliver the level of funding required to provide such services on the NHS, same day, for the demand of the consumeristic patient.

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  • Vinci Ho

    You have been suggesting that all this time anyway , Andy. But you have to be very 'careful' how you are to word this to people.
    The ratio of partner to salaried GP is what will be an interesting debate in next government .
    Again advantages against disadvantages. Large , corporate organisation against small to medium sized business. The 'nature and true face' of these larger integrated organisations can be contentious .
    100% salaried GPs in primary care is not the perfect Holy Grail......
    Anyway, good luck to all Evertonians for tomorrow night Europa League.( Of course, to the Scots tomorrow as well)

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  • Yeah, Good luck to the Scots and maybe the NHS reforms will frighten away the Irish and Welsh next. Westminster has only itself to blame for the party.

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  • Seriously why do we put up with this rubbish?

    It's fairly obvious that pay and conditions would be far worse under a salaried model and patients would not get the same commitment. Costs would also rise as independent GPs do so much unpaid work and I seriously doubt we have enough GPs if we are restricted to EWTD hours.

    There is only one logical solution and that is to remove political meddling from primary care by moving to a fully privatized insurance model charging market rates as is done in the rest of Europe. The alternative is death by a thousand cuts and ever more politicos making money off our backs whilst further damaging patient care.

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  • So all the primary care problems will be solved by being salaried not partners? Who would have thought that the answer was so easy? Aren't we all fools for not seeing it, right in front of our noses?

    Or maybe it is Mr Burnham who is the fool. Do you really think that whether a GP is a partner or salaried makes the difference Mr Burnham? Well let me confirm that you are right! A partner does quite a lot more work than salaried in my experience, so your great plan, Mr Burnham, will see less work done by the same number of doctors. Genius!!

    Of course the real reason behind this puerile scheme is not to improve patient care but to find a scapegoat for the NHS's deep problems caused by politicians, and GP Partners.

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  • Bob Hodges

    Salaried GPs might actually take leave when they're ill, and go home when they their 'shift' finishes'.

    Be careful what you wish for.

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  • i actually dont have a problem with this in principal
    -large scale organisations would have to cover my indemnity, sick leave etc. I have always thought independent contractor status was overrated.
    HOWEVER - somebody better tell me what will happen to the mortgage on a surgery that has 22 years to run and is in significat negative equity. Will I be left with this albatross?????????

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  • Harry Longman

    Mr Burnham, so well meaning, such dangerous ideas. When all of Europe wants to be more like the NHS, you are digging up the foundations. Continuity is the bedrock of general practice, which is the bedrock of the NHS, the world's best healthcare system. Your plan will destroy it.

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  • Sorry, I saw 'New Labour' opening general practice and the rest of the NHS to big corporations and profiteers and salaried doctors who had to work to minutes of throughput before continuity and breadth of generalist care of patients . What we need after the election is a commitment to better funding of NHS provided care. Local NHS practice collaborations (federations, networks) allow the autonomy of partnership with the strength of shared governance and care. Salaried doctors within practices need respect, good wages and conditions and partnerships should provide these but I don't trust companies to deliver on any of this.

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  • Its easy to say - you will all become salaried. There ar younger GP`s who don`t want partnerships. What happens to us partners. Most of us own our buildings,and essentially run small businesses. Where will the money come from to buy us all out?Even twith the goodwill clause , they would still have to pay for our buildings, or we would keep them/sell them for other use . A few will go under , as we see starting to happen, but the majority won`t anytime soon. If pressurised there would be a revolt at some point surely, with GP`s leaping from the BMA/RCGP to an alternative union .

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  • Seriously? He thinks this set up would appeal to more doctors? Perhaps visit a few good practices and find out what makes them so good rather than listen to whoever is currently giving advice like this and plotting the destruction of British general practice in order to keep random unnecessary political "promises" he has made.

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  • What will our all trade union and RCGP do about this. Sweet Funk All. they will lie down and let thier little tummies be tickled by the policitians, say wonderful phrases like "yes sir" and "how high sir". What a complete waste. All resign the BMA. I did and use the extra £300+ for useful charitable causes. At least some one benefits.

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  • If you own your own building you're likely to be in a good position as long as its not a converted semi.
    Settling up new premises is a serious cost and partners with buildings are likely to have some play in this. Regular salaried jobs will become a problems especially as GMS contracts are renegotiated.

    I suspect practices shouls try to merge and become local provider companies

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  • surely being a partner could be double edged.

    if you're in a city practice you have risk in terms of contract but your building could easily be sold for residential.

    If you're semi rural its unlikely anyone would or could invest in buildings in a worthwhile manner so your practice property would hold value.

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  • politicians can't help fiddling, considering how small our part of the budget is - major secondary care reform may be more productive although I wouldn't trust them with that either

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  • local pms and apms practices that exclusively employed gp's were the most costly and also had the lowest patient satisfaction

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  • Small practices consistently score more highly in patient satisfaction surveys and, I suspect, are much more rewarding places to work in. Do he really expect the workload to get done when all partners are made salaried? Has he no idea at all about the additional unpaid hours that partners put in?

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  • I wonder if Mr Burnham will promise no top down reorganisation of the NHS

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  • Come on GPC- the bullies have been throwing rocks constantly the last few years, time to grow some muscles and fight back!

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  • Only one thing that will work with these muppets..
    #MASSRESIGNATION
    then immediately charge patients a 'professional wage' per appointment that compares with equivalent professionals such as lawyers and accountants (albeit probably less than a plumber).
    This will certainly make the political parties popular with the electorate ;)

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  • I always find it extremely interesting that GP partners who are happy to employ salaried doctors balk at the rates of pay when suggested for themselves.
    Double standards I am afraid. I was recently shocked the hear that an ex female trainee at our practicing is being paid less than a male counterpart doing the same job!
    And we wonder why no one has much patience for us

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  • Anonymous | GP Partner | 17 September 2014 11:16am

    Oh dear trolls out again

    I think this story demonstrates real worries if you are a salaried GP and ongoing risk as a partner.

    By the way its the risk bit which GP Partners do which should carry a significant premium - its not at the moment though!

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  • There's so much that GP partners do for free. If you count the hours up you'll find the hourly rate lower than the current average salaried GP rate... So it's going to cost the NHS a lot more money to pay GPs to do all the work and attend all the meetings. The highest earning partners will take a hit but then they'll get a chance to go home at a reasonable hour and enjoy some time with the family. No more covering colleagues for emergencies. No more stress of CQC/ property maintenance. No more ordering supplies! We'd be able to concentrate on patients. No more jumping through hoops as our employer would have to negotiate changes with us.

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  • Excellent idea. worked so well when they changed the consultant contract to stipulate their working hours more accurately. Oh no, wait, they found that many consultants were working many more hours than they thought and on trying to cut down their hours alienated the workforce who started to keep to their contracted hours and not stay longer than necessary. And take more sick leave.

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  • What a plonker he is - does he not realise that this will cost the nhs a sod of a lot more as he will need to add additional paid hours to get what the partnerships provide as goodwill as they are looking out for best interest of patients

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  • Many partners will be better off under such a scheme as their sick leave would be paid for, employer pension costs would be met by state rather than partners themselves - however you will need to employ many more of them to cover what partners do now working in excess of EU Working time directive etc
    Mr Burnham is speaking through his......................

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  • Anon 1116

    Adverts for slaried jobs are 70-85k.

    By the time you add the employers pension to that you get close to partner drawings - that's without the extra work and responsibilities being a partner carries.

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  • They are lacking GPs in Scotland, maybe this will help their recruitment. What perfect timing for the Scottish referendum.......

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  • Anon 1155 exactly

    Anon 1139 I take offence at being called a troll as someone who has worked as a GP for 20yrs plus and have been full time partner in very busy practice

    I have taken to going anon as I find when people present an alternative view they are jumped upon in these columns.

    I am very aware of how hard partners work but my experience of salaried doctors has been very positive and I do not find them to be the clock watching sicky taking doctors that seem to be portrayed in regular contributions to this forum.

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  • Bring it on!! 37 hour weeks (not 60+) and taking sick leave when needed... Paternity...protected education time etc. etc. Oh. One slight problem. The NHS can't afford it. Partners are cheap labour. It's time people realised it.

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  • ‘I can very much envisage a future where we have more integrated care organisations that employ GPs, and the GPs will sit at the centre of teams that are multidisciplinary. They may be the decision maker if you like, or the kind of ultimately accountable person operating this different model of care.’

    Basically what Burnham wants is everything to be stripped from General Practitioners (especially pay) but for all the responsibility to stay. Infact with integrated social care they will want the GP to take the blame for failings in social care as well.

    I can only see medical graduates flooding to a poorly paid, tesco like service for which you will have to accept responsibility for the actions of whoever your employer employs as the "centre" of a combined team of lowest paid NHS badged private company.

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  • Anonymous | GP Partner | 17 September 2014 12:19pm

    But its interesting that you seem to have no understanding of the basics of partnership!

    Of course there are some good salaried GP's but there is a generational shift. some understandable reasons - but the risks associated with partnership have never carried a reasonable premium and that is what partners should be structuring into their practices. i.e replacing salarieds with NP/phone appts etc

    If you're not being paid for your risk why are you taking the risk?

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  • GP partners should consider how the kind of comments which are contained in this thread seriously dis-engagement salaried GPs

    Where are the comments from the contributors who normally laud the return of a Labour Government as the saviour of General Practice

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  • I'm just wondering why any politician - or NHS England - thinks that the stated plans to abolish the current model of General Practice and reduce primary care to a supermarket model will be either popular with the electorate or lead to a solution to the GP workforce and training crisis.
    What am I missing in political and NHS England thinking?

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  • Time to get out of UK general practice if you possibly can!

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  • Mary truth is no one cares about GP I promise you that , even GPs do not care about each other.lets not start about our secondary care colleagues --yes I know the token exceptions -- ..it's a dog eat dog world out there
    Bottom lune is we are a whipped no backbone no balls bunch of pansies .... Sure there are the occasional Spartacus and Spartans among us but let's be honest we do not have an army or any cavalry waiting in the wings . We may be able to hold off a whole marauding army ie privatisation money hungry ..with no responsibility ..organisations ( remember it's always the doctors fault -confirmed by sanctimonious holier than thou fair weathered colleagues)
    That may explain a lot . However the above is an opinion any relation to anything similar in reality is purely coincidental and has no significance to anything living of deceased .it was all heard over a drink in a non medical bar in a city in UK and was the general opinion of the whole bar and surroundings

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  • 15.09 You are right, nobody is going to stand up for us if we don't stop fighting one-another and stand up for ourselves against NHSE/CQC/GMC.

    The sad thing is that market forces are on our side, with a little thought and planning we could be very powerful. We are a scarce commodity and I doubt the public will like it much when they find out how little care the HMOs are going to be offering them for their money. Ultimately people will always want to see a GP and they will be prepared to pay a premium to avoid 111 like triage.

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  • Well done Andy.
    I think all GPs should be salaried like all other doctors in the NHS.
    GPs are paid too much for the value they bring to the work place. They are not as qualified as hospital consultants yet they get paid similar wages. This is insanity. You can’t keep on ripping off the tax payer. This should end some day!

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  • Una Coales. Retired NHS GP.

    Salaried GP is a minefield! According to a BMA employment advisor, 'You may be sacked while taking your entitled sick leave. Your employer may begin a disciplinary process or termination if they believe you are not likely to return.

    (Remember how trusts may get rid of NHS consultant whistleblowers...vexatious complaints, disciplinary, suspension, referred to the GMC for gross misconduct)

    Sick pay? An employer may only pay you statutory sick pay (approx £85.80/week) unless specified otherwise in your contract.

    Disciplinary? You may only bring a professional colleague or trade union advisor to a disciplinary or grievance hearing. This means no lawyers or family.

    And finally 'Legislation does not ensure that your legal rights are upheld, although you are entitled to compensation. This means employers may break rules!'

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  • Why does anyone think APMS contractors or NHSE will employ us under the current BMA model contract? Any one that has done the math will know the model contract is unbelievably lucrative in favour of the salaried GP.

    As it is only the GMS contractors that has to adhere to the model contract, any other providers will formulate their own contract i.e. much worse T&C.

    I think the salaried GPs should be very worried - of they think the partners are exploiting them, wait until you see what a truely commercial private provider will do with you. There are plenty of APMS practices who struggle to retain their salaried GP for this very reason, and they haven't even down their color yet.

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  • Peter Swinyard

    The 4.11pm daily wail type "work for health provider" contribution to the debate is interesting.
    Curiously, it takes a minimum of 9 years to train as a GP (similar to hosp consultant). Both need postgraduate qualifications of similar difficulty in achieving. The GP has continuing responsibility for patients, the consultant episodic. The majority of consultants have the opportunity to enhance their salaries with private work. The majority of GPs do not. Consultants' income is guaranteed. GPs' income has fallen by 10-25% in the last 3 years.
    If you cost a GP consultation - with all the risk management involved - you find that they are less expensive than a similar consultation from an experienced nurse.
    I do not think this is a rip-off of the taxpayer. Rather the converse as all the facts (not the heterodox opinions of those jealous of a GP's qualifications) show that GPs provide by far the best value care in this NHS - and are envied for their cost-effectiveness around the world.
    But never let facts get in the way of jealousy and prejudice.

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  • Do you really think GPs would work 100 hrs a week if they were not partners !! Cloud Cuckoo Land !!
    He would have to double the numbers and accept the cost implications !!
    It shows a complete lack of undertanding and insight into the current situation.
    But he is only a politician !!

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  • I have already resigned as a partner having worked twice the equivalent number of hours as most sixty year olds, carried massive clinical and financial risk for the NHS and politicians, earned less per hour than salaried doctors with much less experience and accountability, and put patients and the job ahead of my family and own health when push came to shove for the first two decades (no longer!), because that was what we did. And I've done some good, and some patients have appreciated it. The NHS and politicians don't care and patients don't realise what how bad it's going to get (yet). I'm leaving because I am not going to be made the fall guy.

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  • Dear 4.11 "Healthcare work provider"

    In all humility you couldn't know what its like to work as a full time GP partner in 2014? If you did you wouldn't have said what you've stated. My previous neigbours were hospital ENT consultants who my wife tells me got home before I did and had far more time off - I've had 3 days of this summer - 1st break in 2 years. My ENT surgeon neighbours earned 2-3 times what I earn.

    I've decided to retire early - if you could let me know of any GP jobs round where you live where the pay is nearly as good as the hospital consultants and I can work fewer hours - I'm your man.

    I suspect however you are nothing more thasn a Daily Mail reader who is going to vote UKIP at the next election - what political party is Andy Burnham in? Sounds like he's in the Tory party along with NHS England who have got us into the fine mess we are in.

    Independent self employed GP partnerships are the answer to the current crisis in General Practice not the cause. The solution - investment in new GP premises and a decent pay rise to bring GP incomes back up to hospital consultant levels we enjoyed in 2004/05. Turn the clock back and General Practice will go through a revival.

    Salaried GP walk in services is the end of General Practice as we know it and we will end up like USA - hospital led expensive health care out of the reach of 1/3rd of our population. This is what the Tories and NHS England want - and some of RCGP - but not in these United Kingdom of Great Britain and Northern Ireland - we are better than this.

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  • Politicians live in cloud-cuckoo land. I'm a Partner and the reason I became one was to work hard and build my practice up into something I could be proud of. I've put countless hours at work and at home.. Well, if this is what they want, I'm happy to be one. Less stress (we haven't been able to employ doctors for two years now) and less work. Locums have it nice. No management concerns, they just see patients and treat/refer. Once we become salaried there will be no goodwill. Then, they will realise how much they have lost just because they want to pay us less. My income has dropped 25% and further as our costs are up and income down. I've been scouting for work abroad and will definitely jump ship - Qatar, Saudia, Canada etc. I don't feel valued now. It's just criticism all the way through. Even patients moan but general practice is getting worse. Good luck with finding salarieds. I won't be one of them.

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  • I cannot trust my GP practice because I always have the suspission they are more interested in optimising their QOF payments than my health. BP not taken unless it is "due" despite reporting symptoms that may be related to blood pressure. If tyou dont want to be salaried, then enjoy your "retirement". Nurse practitioners are who many patients have to see, unless they book weeks in advance so the reality for many patients is they would not even notice.

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  • Burnham is right.GP partners have had it good for too long enjoying the tax benefits of self contractor status whilst reaping the benefits of a state pension with interest payments for the cost of their private premises all paid for by the tax payer whilst they keep all the capital gains.A deeply immoral rotten system that needs to be urgently replaced.

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  • Dear anonymous nurse.

    God help us when us GPs have been replaced by nurse practissioners.

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