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GPs buried under trusts' workload dump

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)

  • 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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  • This comment has been moderated.

  • @6:41 - it is sad you are upset - but please think of the alternatives:
    The government/ NHS pays notional rent to GPs that own property. If the practices were not owned by GPs they would still have to pay someone. They would probably pay commercial rent which would be a lot more expensive. Before suggesting they buy all the GP surgeries it is worth noting they cannot even afford to buy the hospitals let alone 10000 GP surgeries. Remember that the government is not charged for the maintenance of those practices other than notional rent.

    I am not quite sure you understand the tax benefits of self contractor status. It is not as good as you think. Salaried GPs can claim almost entirely the same expenses as contractor GPs. The government saves the money on processing the tax of each GP - as that is done through accountants (which probably totals 500-1000 pounds per GP per year.

    You pension idea is completely wrong. GPs do not get the government to pay their employers contribution towards their pension. It is instead funded themselves. So GPs pay 28ish % of their pay into the pension pot whereas a consultant only pays 14%.

    Then there are many downsides of contractor status. The biggest is the hours work. To replace my time you would need 1.5 salaried GPs to see my appointments and 0.33 gp practice managers to do my management work. The total cost of that is a lot more than my take home pay.

    GPs with dispensaries (not me) save the NHS a lot of money compared to those same patients going to a pharmacy. Yes the GP makes money for managing those patients - but it still costs less than a pharmacy.

    Finally if you make GPs employed you will lose the one part of the NHS that is focussed on keeping appointment costs down. GPs manage things efficiently because that is in their favour. A GP could make his life easier by following up patients more (rather than seeing new problems) using appointments for blood results (rather than dealing with them over the phone) and spreading work over 3 appointments that could be managed in 1 or 2. If salaried and disenfranchised that will happen more (it already does with many salaried GPs) and that will more than outweigh any superficial cost savings.

    The bottom line is as follows. For a patient to see an employed senior doctor in hospital for asthma OR a junior member of that team with asthma OR a senior doctor in A+E with a cold OR a junior doctor in A+E with a cold OR a nurse practitioner in A+E with a cold it costs the taxpayer/ NHS/ CCG 120-200 pounds.

    To see a GP in a partner led surgery OR nurse practitioner in a GP surgery for a similar reason to above it costs the taxpayer/ NHS/ CCG about 15 pounds.

    Which one is really ripping off the public?

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  • Going to have to vote for the Green Party at this rate

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  • All the GP partners are saying the same thing - Independent contractor status is a bargain for the Government.

    Why do they not believe us ? Why do they listen to management and business consultants in preference to the professionals ?

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  • 'Burnham is right.'

    Not sure if you are being sarcastic? Partnerships are phenomenally efficient which is why APMS costs so much more to run per patient.

    'GP partners have had it good for too long enjoying the tax benefits of self contractor status'

    Partnerships are not particularly tax efficient compared to limited liability companies for example. Many professions in this country are self employed, this is nothing special.

    'whilst reaping the benefits of a state pension'

    We work for a monopoly employer, the pension arrangements were part of the compromise made when GPs lost their private income in 1948. Despite this the government unilaterally changed the contract so GPs have to pay much more into their pensions. Reduction in lifetime allowance is forcing GPs into retirement when primary care is facing a recruitment crisis.

    'with interest payments for the cost of their private premises'

    Many practices are in fact leased so there is little gain to make. Investment in premises is at an all time low which is why we have major capacity problems both for seeing patients and training new GPs and nurses. Many premises are struggling to meet CQC requirements. The last time I checked, consultants were not being asked to mortgage their hospitals or bear the liabilities for lease holds.

    'All paid for by the tax payer whilst they keep all the capital gains.'

    Er - perhaps I better tell the bank that practice loan I took out (at personal risk) was in fact a mirage and therefore the bank does not require me to pay it back!

    A deeply immoral rotten system that needs to be urgently replaced.

    What is so immoral about a system that the OECD feels is the most efficient in the western world? http://www.telegraph.co.uk/health/healthnews/8877412/NHS-among-best-health-care-systems-in-the-world.html

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  • The benefit of being a partner is the sense of ownership and some modicum of control over the practice and your working situation. The sense of a team your the head of, and mostly an ongoing relationship with patients and a sense you're helping people and the wider community. In days gone by there was gratitude, praise and respect now replaced with expectancy, entitlement and complaints.
    Older GPs enjoy this and put up with the long hours and low pay for those intangible benefits.
    The main benefit is to the patients, bit as we can see from a few earlier posts the government and the press have succeeding in painting us as over paid lazy and underqualified tycoons. Ha!
    As a younger doctor I am loath to take on the commitment of partnership having tried it for 6 months(convinced by the hype myself) quickly realised all my wages went on the pension and I couldn't handle the hours and stress. I think well be better off as salaried in many ways but the patients wont have a GP or family doctor in a true sense of the word. They will flit from one doctor or clinic to another and no one will know or care who they are, nor follow up on them(this is how it is in Canada where im currently working with out stress, and I never think about my patients when at home as I did before yet the patinets respect me and it still surprises me but they accept my advice witout constant doubting). But at least the public wont be able to blame us for everything as we will be working for a company and poor access is their problem.
    I would try partnership again, as TBH, my circumstances were not right before and I wanted to travel, work abroad etc. but will there still be partnerships to apply for?
    Its sad that we are so undervalued and no longer respected and the thought of us earning a descent professionals wage for a fair days work seems so difficult for people to stand. Not too late to get in to accountancy.The benefit of being a partner is the sense of ownership and some modicum of control over the practice and your working situation. The sense of a team your the head of, and mostly an ongoing relationship with patients and a sense you're helping people and the wider community. In days gone by there was gratitude, praise and respect now replaced with expectancy, entitlement and complaints.
    Older GPs enjoy this and put up with the long hours and low pay for those intangible benefits.
    The main benefit is to the patients, bit as we can see from a few earlier posts the government and the press have succeeding in painting us as over paid lazy and underqualified tycoons. Ha!
    As a younger doctor I am loath to take on the commitment of partnership having tried it for 6 months(convinced by the hype myself) quickly realised all my wages went on the pension and I couldn't handle the hours and stress. I think well be better off as salaried in many ways but the patients wont have a GP or family doctor in a true sense of the word. They will flit from one doctor or clinic to another and no one will know or care who they are, nor follow up on them(this is how it is in Canada where im currently working with out stress, and I never think about my patients when at home as I did before yet the patinets respect me and it still surprises me but they accept my advice witout constant doubting). But at least the public wont be able to blame us for everything as we will be working for a company and poor access is their problem.
    I would try partnership again, as TBH, my circumstances were not right before and I wanted to travel, work abroad etc. but will there still be partnerships to apply for?
    Its sad that we are so undervalued and no longer respected and the thought of us earning a descent professionals wage for a fair days work seems so difficult for people to stand. Not too late to get in to accountancy.The benefit of being a partner is the sense of ownership and some modicum of control over the practice and your working situation. The sense of a team your the head of, and mostly an ongoing relationship with patients and a sense you're helping people and the wider community. In days gone by there was gratitude, praise and respect now replaced with expectancy, entitlement and complaints.
    Older GPs enjoy this and put up with the long hours and low pay for those intangible benefits.
    The main benefit is to the patients, bit as we can see from a few earlier posts the government and the press have succeeding in painting us as over paid lazy and underqualified tycoons. Ha!
    As a younger doctor I am loath to take on the commitment of partnership having tried it for 6 months(convinced by the hype myself) quickly realised all my wages went on the pension and I couldn't handle the hours and stress. I think well be better off as salaried in many ways but the patients wont have a GP or family doctor in a true sense of the word. They will flit from one doctor or clinic to another and no one will know or care who they are, nor follow up on them(this is how it is in Canada where im currently working with out stress, and I never think about my patients when at home as I did before yet the patinets respect me and it still surprises me but they accept my advice witout constant doubting). But at least the public wont be able to blame us for everything as we will be working for a company and poor access is their problem.
    I would try partnership again, as TBH, my circumstances were not right before and I wanted to travel, work abroad etc. but will there still be partnerships to apply for?
    Its sad that we are so undervalued and no longer respected and the thought of us earning a descent professionals wage for a fair days work seems so difficult for people to stand. Not too late to get in to accountancy.The benefit of being a partner is the sense of ownership and some modicum of control over the practice and your working situation. The sense of a team your the head of, and mostly an ongoing relationship with patients and a sense you're helping people and the wider community. In days gone by there was gratitude, praise and respect now replaced with expectancy, entitlement and complaints.
    Older GPs enjoy this and put up with the long hours and low pay for those intangible benefits.
    The main benefit is to the patients, bit as we can see from a few earlier posts the government and the press have succeeding in painting us as over paid lazy and underqualified tycoons. Ha!
    As a younger doctor I am loath to take on the commitment of partnership having tried it for 6 months(convinced by the hype myself) quickly realised all my wages went on the pension and I couldn't handle the hours and stress. I think well be better off as salaried in many ways but the patients wont have a GP or family doctor in a true sense of the word. They will flit from one doctor or clinic to another and no one will know or care who they are, nor follow up on them(this is how it is in Canada where im currently working with out stress, and I never think about my patients when at home as I did before yet the patinets respect me and it still surprises me but they accept my advice witout constant doubting). But at least the public wont be able to blame us for everything as we will be working for a company and poor access is their problem.
    I would try partnership again, as TBH, my circumstances were not right before and I wanted to travel, work abroad etc. but will there still be partnerships to apply for?
    Its sad that we are so undervalued and no longer respected and the thought of us earning a descent professionals wage for a fair days work seems so difficult for people to stand. Not too late to get in to accountancy.The benefit of being a partner is the sense of ownership and some modicum of control over the practice and your working situation. The sense of a team your the head of, and mostly an ongoing relationship with patients and a sense you're helping people and the wider community. In days gone by there was gratitude, praise and respect now replaced with expectancy, entitlement and complaints.
    Older GPs enjoy this and put up with the long hours and low pay for those intangible benefits.
    The main benefit is to the patients, bit as we can see from a few earlier posts the government and the press have succeeding in painting us as over paid lazy and underqualified tycoons. Ha!
    As a younger doctor I am loath to take on the commitment of partnership having tried it for 6 months(convinced by the hype myself) quickly realised all my wages went on the pension and I couldn't handle the hours and stress. I think well be better off as salaried in many ways but the patients wont have a GP or family doctor in a true sense of the word. They will flit from one doctor or clinic to another and no one will know or care who they are, nor follow up on them(this is how it is in Canada where im currently working with out stress, and I never think about my patients when at home as I did before yet the patinets respect me and it still surprises me but they accept my advice witout constant doubting). But at least the public wont be able to blame us for everything as we will be working for a company and poor access is their problem.
    I would try partnership again, as TBH, my circumstances were not right before and I wanted to travel, work abroad etc. but will there still be partnerships to apply for?
    Its sad that we are so undervalued and no longer respected and the thought of us earning a descent professionals wage for a fair days work seems so difficult for people to stand. Not too late to get in to accountancy.

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  • sorry re above copy and past error should just be this:

    The benefit of being a partner is the sense of ownership and some modicum of control over the practice and your working situation. The sense of a team your the head of, and mostly an ongoing relationship with patients and a sense you're helping people and the wider community. In days gone by there was gratitude, praise and respect now replaced with expectancy, entitlement and complaints.
    Older GPs enjoy this and put up with the long hours and low pay for those intangible benefits.
    The main benefit is to the patients, bit as we can see from a few earlier posts the government and the press have succeeding in painting us as over paid lazy and underqualified tycoons. Ha!
    As a younger doctor I am loath to take on the commitment of partnership having tried it for 6 months(convinced by the hype myself) quickly realised all my wages went on the pension and I couldn't handle the hours and stress. I think well be better off as salaried in many ways but the patients wont have a GP or family doctor in a true sense of the word. They will flit from one doctor or clinic to another and no one will know or care who they are, nor follow up on them(this is how it is in Canada where im currently working with out stress, and I never think about my patients when at home as I did before yet the patinets respect me and it still surprises me but they accept my advice witout constant doubting). But at least the public wont be able to blame us for everything as we will be working for a company and poor access is their problem.
    I would try partnership again, as TBH, my circumstances were not right before and I wanted to travel, work abroad etc. but will there still be partnerships to apply for?
    Its sad that we are so undervalued and no longer respected and the thought of us earning a descent professionals wage for a fair days work seems so difficult for people to stand. Not too late to get in to accountancy.

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  • Let's all get salaried!! The first thing I'm going to do is to get signed off sick by my GP for ' stress at work'. Staying at home when I'm ill or sometimes 'having a tummy bug ' like our salaried GPs seem to have all the time is like a dream come true -Andy buy my practice and all the hassle for a fair price and finally I will have some rights myself and maybe Andy ,you will find out for yourself that General Practice is not as easy as it looks.
    I think I'll vote Labour next time.

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  • Reply to Harry Longman,

    You need to get the word "continuity" right, a very institutional word like many other words being used,
    patient care, support, help.

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  • Una Coales. Retired NHS GP.

    @11:45 pm Andy Burnham is a LABOUR MP and Shadow Secretary of State for Health.

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  • Another addition to the which Politician can make the most ludicrous, uninformed and outlandish comment about general practice. Well done Mr Burnham for displaying a complete lack of understanding and sympathy for primary care and its challenges.

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