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Gerada: GP partnerships likely to be gone within a decade

Exclusive GP partnerships in London are likely to be history within 10 years, former RCGP chair Professor Clare Gerada has told Pulse, as they offer no ‘autonomy’ and are a ‘millstone around our necks’.

In an exclusive interview with Pulse, Professor Gerada – who is now an advisor with NHS England (London) – questioned whether the independent contractor status gives any benefits to GPs, claiming that because of today’s workforce demands on the profession, it’s time to ‘look at alternative models’.

She added that she does not believe that all GPs in London will be salaried in 10 years’ time, but there will be different models of care, and she said the independent contractor model would continue to exist outside London.

Pulse was speaking to Professor Gerada following the publication last month of NHS England (London)’s ‘transformation framework’ – led by Professor Gerada – which outlined plans for practices to merge or federate to offer routine opening on Saturdays and offer flexible appointment lengths as part an £810m a year bid to reshape general practice in the capital.

Her comments come as NHS Hull CCG revealed last month that it is in talks with GPs about a projected move to a completely salary-based model of primary care, in a bid to tackle major recruitment problems in the area.  

Professor Gerada’s thoughts also echo comments made by shadow health secretary Andy Burnham, who previously told Pulse that the profession ‘should move towards becoming predominantly salaried,’ while NHS England deputy medical director Dr Mike Bewick said earlier in the year that GP partnerships will be ‘gone within ten years.’     

At the RCGP conference last year, while still college chair, Professor Gerada called for GPs to give up their independent status and become salaried employees, saying that the independent contractor model was ‘anachronistic’.

But, speaking to Pulse this month, she went further, arguing that the GP partnership model would be an anachronism in the capital within a decade.

Professor Gerada told Pulse: ‘I don’t think everyone will be salaried. I think there will be different models. I think we’ve already seen it in London. If you say will there be independent contractors in London in 10 years’ time, I suspect not.

‘But if you ask whether independent contractor status will remain in some areas of Britain – yes of course it will. I would question whether the independent contractor status is beneficial to GPs. With today’s workforce, today’s demands on general practice, with the media seeing us as fat cats going off to play golf every afternoon because we are independent, I think this is a millstone around our necks and the sooner we look at alternative models the better.’ 

Professor Gerada foresees GPs being independent contractors to primary care organisations, adding that ‘new models will emerge’.

She said: ‘But the partnership model has stood the test of time for 70 years and it will probably stay around in certain areas. We could even be independent contractors to a primary care organisation. I think models will emerge. I’m not saying one size fits all.’

She went on to add that these new models could include completely salaried structures.

‘Shareholder models are already emerging. Social enterprise models, or completely salaried models, even models of foundation trusts employing GPs. You need to work out want you want to deliver, make the system safe, not for profit, then GPs with the right resource will make anything work,’ she said.


Readers' comments (53)

  • Nigel, love it!

    Sadly, you are completely right.

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  • Una Coales. Retired NHS GP. Russell Brand on the future of the NHS and privatisation. I disagree with Clare's model of a salaried profession as mentioned in Pulse

    Already over 19,000 have read my blog article on salaried GPs with a breakdown of financial income and how one is to repay student loans of up to £100k.

    IMO medical students are avoiding general practice BECAUSE it is becoming a salaried 'staff grade' service which runs the risk of assembly line medicine with lay managers being the 'boss of them'.

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  • "The salary will simply not be enough for those doctors needing to work full time to support a family. They will all choose secondary care."

    And back in the real world, the national average salary is £26500. Wants vs needs. Wants vs needs.

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  • Oh dear - another "other HCP" who is has doctor envy.

    No-one is claiming that doctors are on the bread line and cannot make ends meet. But it's a simple case of economics and supply/demand.

    Imagine a newly qualified doctor at a crossroads. One road leads to a starting NHS salary of 75K and the potential for private earnings. Another road leads to lifelong earnings of no more than 50K. Which do you think they will choose?

    I make no apology for my income as I believe I am worth every penny and more. As a someone with lifelong left winged views, I find it amusing that the British public are almost communist on this one issue alone - everyone earning the same. Yet, misogyny and xenophobia still prevail.

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  • Actually in the real world (anon@12.01) one "needs" to pay enough to attract people into the job - good luck to you if you think you'll find enough people willing and able to take on our jobs and responsibilities for less

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  • Clare has clear, and probably accurate, strategic view of the future employment model for much, but not all of general practice. However, important safeguards around suitable employing bodies, are needed, to counterbalance some of the less favourable aspects of salaried service mentioned elsewhere. Some time ago the John Lewis model, of employee owned service delivery, was extolled by politicians and I suggest that, despite the recent silence of the issue, it needs to be resurrected as one of several viable structural models for GPs. To enable this, the NHS rules which place restrictions on who or what may hold a GP contract need to be extended to include GP-employee owned Trusts. Perhaps this is something the DoH could have a look at as part of the current planning round.

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  • Of course partners are well over paid. After all we only work about 12 hours more/week then the consultants earning similar over all net income. Come to think of it, emergency plumbers, accountants, bankers, politicians all earn more then partners on actual income/hours worked. (For your information that's around £40/hr before tax and employee pension).

    How dare we complain. We only need 10 years to become a GP and during that time we only need to pass 2 major exams and annual assessments. Partner's has to put their personal asset as risk as business owners but we shouldn't complain as we can always declare bankrupt and get away with liabilities yeah?

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  • Thanks for the useful article Prof Gerada. It helped me to come to the conclusion that general practice has no future in the UK. MCCEE [ Canadian exam] is booked.

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  • I guess profits must be down at the Hurley Group?

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  • Interesting news from Poland where 6000 GPs belonging to ZP ( Zielonogorskie Poruz.) Agreement have refused to refresh Contracts with the government and formed a private company 'Medical Concept' which will now be offering insurance packets to individuals and companies starting 2015.
    Wonder whether that sort of thing could be possible in UK and whether there is enough cohesion amongst GPs to get together on that scale.

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