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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.

Related images

  • Andy Burnham MP 2014

Readers' comments (81)

  • 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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