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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)

  • 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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