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Independents' Day

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)

  • 4.11 -
    This is the target audience for this - the great and tolerant general public

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  • reading through these posts I have to ask myself, seriously, where have we, as a profession, misplaced our backbone???

    Theres not enough GPs, we as a profession still have excellent satisfaction ratings with our population. We carry out 90% of the work of the NHS. Without GPs the NHS would collapse overnight. We only spend 8% of the whole NHS budget.

    GPs are extremely influential people. We are important people. Why are we talking about fleeing the country when we should be protecting our livelihoods?

    We need to man up.

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  • it is probably correct to says partners work harder than a salaried GP but at the same time they are earning 1.5-2 times the salaried gps earnings.

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  • Tony Gu ...the nail that sticks out the most gets hit the hardest
    Friend amigo colleague can you really count on the GP sitting next to you in the next "educational meeting" to watch your back ..really can you ? ,,!
    We are surrounded by Judas' so man up sure but only if you fighting an honourable enemy

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  • Gp reg7:47 are you really aGP trainee ? You are being told left right centre the truth yet you believe the tripe spewed by media ....1.5 -2 x such a load of crock ....look properly and you will it's more like 0.7-0.8 x as much barring the occasional gp who owns 10 practices ie anyone familiar cone to mind

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  • gp reg 7:53
    see the figures below

    "Thousands of GPs paid more than the Prime Minister"
    By Christopher Hope, Senior Political Correspondent

    6:00AM BST 25 Sep 2013

    The average GP partner was paid £103,000 a year in 2011/12, marginally down on the year before, the figures showed.

    Partners’ pay far outstripped GPs who were paid salaries to work for practices. They were paid between £55,200 and £57,100 a year. Mr Hunt is already looking at redrawing the contracts, which were agreed under the last Labour Government in 2004.

    Hope this would help to understand the figures.

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  • And gp reg 1031 you actually believe a politician ? Come on mate that's either very naive or you are hoping to see the good in everything
    Now mute point but 103000 if anyone gets that on average ..let's minus NI , pension contributions for all staff as well as self ..remember nearly double that of hospital consultants I think 28% for self , not including staff , building repairs cost up keep , medicolegal responsibility for everything , no clear freedom of sick leave study leave , no sick pay , defence fees and no fixed income ..this is to name just a few outgoings
    You know I looked into it ..being salaried on 6-7 sessions a week with no legal responsibility as such , advantages of sick pay pension defence fees go home family , etcetc .......think mate ..

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  • Una Coales. Retired NHS GP.

    Why do all political parties want GPs to be salaried workers for hospitals? Here is the answer! A US physician came across a healthcare mx consultancy document entitled 'how to discourage a doctor' and explains to make all doctors salaried for hospitals and why. Shocking!

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  • A little off topic but the GP reg really needs to all his trainer about finance. I often teach registrars about practice income and partner drawings and it is clear most registrars (and many salaried GPs) do not understand this as it is not taught by many trainers.

    In fact, many newly recruited partners are bitterly disappointed they have taken a "pay cut" compared to bring a salaried our locum whilst their current account is building up.

    Just to put things in to perspective, I calculated my income per actual hour worked, with partner unique costs taken out (employee's contribution of pension, locum insurance, etc) but not taking out usual tax, employee's pension, indemnity etc, it was £40/hr. Less then reported average pay per hour of salaried GP.

    Hope this would help to understand the figures

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  • Una Coales. Retired NHS GP.

    @9:25 am in my day, registrars did ask to see the practice accounts as it was part of the curriculum. Alas I was never shown the practice accounts which made me suspect there may have been a pay discrepancy between GP partners and salaried GPs. So I asked the salaried GP how much she was paid and worked it out for her as an hourly rate of £40/h. I informed her the locum rate at the time was £60/h and why she wished to work for less? Needless to say, she worked her 3 month notice and became an independent locum GP. That was over a decade ago.

    I say to you now, why as an experienced GP partner, do you accept £40/h? Why not show registrars how to become independent private GPs? Show them how to run a practice as a business, staffing costs, etc. and help them build a private practice.

    I sense GP partners think pts will not pay, yet dentists are able to find self paying patients all over the country. Even a taxi driver told me he self paid £200 for a root canal as the NHS only wanted to offer him tooth extraction.

    We are at a transition. There will be two types of GPs, the kind who work long hours for ICOs, like Kaiser, for min pay and little control over their job and the kind who will form partnerships as independent private GPs and buy x ray machines, ultrasounds, pay for a cardiologist to do stress tests in the clinic, etc. I hope GP trainers will at least give all the options to our Generation Y trainees who will shoulder HUGE medical school debts and try to earn a living in a struggling national economy.

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  • Spoke to a partner who said he hasnt had a holiday in 3yrs as he cant afford to pay a locum for cover and cant go on courses as he cant even find a locum! So where are the Daily Mail 250K partners!! He said he would rather be salaried

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  • So many of the posts here are very instructive and should be heard by a wider audience but seem let down by weariness with your professional bodies that don't seem to represent you. Whilst I can see the differences in opinion are based on age or experience or other factors, what is common to all is that the solution is based on your informed opinions. Much of the NHS and general public are completely oblivious to the history of the GP contract and why we're in the mess we're in. Instead we fly people over to Kaiser to ooh and ah over their models or get issued idiotic missives that we have to implement knowing they are wrong or read cr@p in the tabloids and believe it.
    I think that the future of general practice is integral to the future of the NHS. Surely this is time for a concerted, structured campaign, with evidenced messages to all the various parts of the "market"? By that I mean segmenting how we inform the public of the implications, get some positive traction in the mainstream press and lobby politicians to have some common sense. Never has such a profession been so poorly treated and undervalued. It makes my heart sink to see that so much good care is reliant on so many tired people, who hang on and do the best for their patients because they care.
    I am worried for my old age. I don't want to look back on these years and see the missed opportunity.
    So many of you are looking to leave and go abroad, I fear that the panic of not having enough doctors will force stupid decisions. We need a Nye Bevan for primary care.

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  • Bob Hodges

    I'm 39 next week.

    I work 4 days a week in GP, One day per week in Commissioning/LMC week and do at least one OOH session per week as well.

    I won't be doing ALL that by the time I'm 40 I can assure you. There is no one offering to take my regular OOH shifts. No one wants to do more daytime sessions so I can cut back. The Commissioning/LMC pays me much more per hour than GP (no expenses to pay), and I enjoy that work so I don't want to do less.

    There's a WHOLE lot of trouble coming to health service near you in the next few months.

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  • The government want GP's to be salaried to enforce more stupid rules on them, do as I say or you are gone!

    What the NHS needs more than anything else it to leave GP's to do what they do best ... care for patents!

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  • I am a salaried GP in a busy practice and I can say the partners work much longer hours then I do just to get the work done which WOULD NOT be the case if they were salaried. What a ridiculous suggestion having all salaried GP's in large organisations, I for one will not be working for one of these organisations for sure!

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  • Una,

    I tell the registrars the locum rates, pros and cons of salaried/locum/partnership work. I even show them my accounts to explain the finance, just like my trainer did when he taught.

    It might surprise you but I choose to stay as a partner because my reason for being a GP isn't purely about income. I know I can earn more with less risk by being a locum.

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  • Una Coales. Retired NHS GP.

    @10:03 am well done for fully informing your registrars and for attempting to hold the fort as a GP partner in a losing battle. I worry about GP partners' wellbeing having learned of 2 GP partner deaths, both male and aged 53. I fight against needless deaths and now it seems that GP partners are heading for an early grave with all the inordinate amount of stress, targets, conditions, etc. to deliver a financially unfeasible contratct. You say it is not about the money. When a GP partner's pay dropped from £130k to £60k, it is much harder to say it is not about the money. A surgery depends on money to pay locums to cover for sick partners, to pay for practice nurses and admin staff, to pay for redundancies, to pay for the lease. Eventually one has to admit that being a GP partner is about the money as you have to run a business. The question then becomes what is your bottom price as this is what the government is forcing GP partners to decide and also what is the price of your self esteem?

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  • Thanks for the comment Una. As I am a partner in charge of practice finance, I agree with you about the balance between reward (income, job satisfaction, personal principles) against work load/risks.

    The balance has shifted significantly against partnership and as Britain is poorer this will only continue in a false assumption salaried model is cheaper. But I'm afraid salaried/locum GPs will also feel the blunt of this, and in my opinion their positions are more vulnerable then the partners as they have less control of their work environment then the partners do.

    I don't believe the answer to this is to further fragment the profession by encouraging younger colleagues to only consider the immediate income and current job stability - we will have a bigger voice and stronger ground if we unit together.

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  • What a bunch of wingers GPs are. Work hard my backside! I have been trying to see the same GP twice in my practice of 10 part-timers, and two full timers for months, I have failed - despite knowing the system and being a partner in the area for 15 years before leaving for the saner sanctum of the private sector. There is NO continuity, no empathy, no coordinated care for the two significant LTCS I have developed (Not lifestyle/obesity related before some wit chimes in, though I could lose a bit of weight and take more exercise), no appointments for weeks, no hassle free repeat prescription service, no explanation of what I can expect from them in light of my diagnoses, just rushed one problem appointments with GPs catching up on the notes they should have read before I went into the consulting room and a sloped shoulder approach to come back in a week and see someone else on a day I am not here attitude. Holistic person centered care - what a laugh! Its frankly embarrassing to be part of the same profession, though its educational , as it teaches me how not to behave in front of the people that turn to me for medical care.

    I am happy and have plied my trade as a salaried GP for many years. I work harder now than I did as a partner, earn more than I did as a partner and have a decent pension built up. ITs true I probably have more time to myself, as Im not busy juggling work for the NHS with private work, dealing with accountants etc that contribute considerable workload on a few partners.

    Thankfully I am not party to the biggest con in health care- that GPs are part of the great public sector NHS - nonsense- they are members of the biggest private cartel in the UK.

    Wake up guys, its time to get real - we need a well run, well led , salaried service that is run for the benefits of people that need health care, not one that is run at the convenience of GPs where people are a nuisance and the only person that matters is 'doctor'.

    Embrace change, leave or provide a rubbish service. Your choice!

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  • Dear cough,cough Salaried GP (fake/insincere doctor, anyone?) 4.21pm - please refrain from using the say old tripe caricature about us that your 'employers' at the daily mail and other like minded rags have been peddling for years. I do wonder why a 'fellow GP' who works in the idyllic world of private practice has not managed to purchase or better still been given by his employer private medical insurance, hence removing the necessity to mingle with the hoy-polloy in NHS GPland that you seem so happy denigrate. Money not as good as you purport? Your employer not thinking your worth it? please tell, please tell!!

    I suspect from the attitude you demonstrate on the here that the real reason you never manage to see the same doctor or get an appointment at will is the practice are well aware of you - in certain quarters the term HEARTSINK comes would reverberate like the sound of thunder and lightening at very mention of your name. Oh yeah before I forget, the other more important reason is that these NHS GPs, like all the others, are seeing the 98% of the UK population who seek primary care services - leaving you I guess to toll with the remaining 2%. You workout the math, and see if can workout the disparity? Now do some more maths and see if you can find a correlation with this and exponential workloads? Is it clear yet? No? Well don't worry, I'm sure private practice is the best place for you to be at present, you've clearly embraced change and left. Good luck if not riddance. Your choice!


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