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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)

  • @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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