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GPs buried under trusts' workload dump

GP leaders to vote on support for fully salaried GP profession

The GPC could negotiate a new contract with Government under which GPs give up their independent contractor status and all go salaried, LMCs have suggested.

A motion to be presented by Oxfordshire LMC at the emergency LMC Conference at the end of the month suggests that because ‘many younger GPs currently prefer to be salaried rather than partners’, the GPC should look at ‘future contractual models’ which ‘explore all options including movement away from independent contractor status’.

Although the Oxfordshire LMC motion is the only one scheduled for debate, several LMCs suggested similar motions to the agenda committee.

This included Mid Mersey LMC, which proposed a motion saying ‘that the days of independent contractors delivering safe and sustainable general practice are coming to an end and calls upon the GPC to actively support the development of a salaried GP service’.

LMCs have voted on the topic before but the motion to move to a fully salaried service has always been voted down.

A Pulse survey of over 600 GPs last autumn found that support for a fully salaried model of general practice is growing, with 26% now in favour. However just over half, 54%, remained opposed. 

The motion follows similar calls by former RCGP chair Professor Clare Gerada and NHS England in London, while NHS Hull CCG has also looked into plans for developing a fully salaried model - which it later discarded,

GPs in Scotland are already moving ‘as close as possible’ to a salaried service as part of the devolved health economy’s new contract model.

The motion in full

OXFORDSHIRE: That conference believes that many younger GPs currently prefer to be salaried rather than partners, and that in looking at future contractual models, the GPC Executive Team should explore all options including movement away from independent contractor status.

Read the agenda in full here

Readers' comments (57)

  • Another Hunt agenda to destroy General Practice totally. I think the people in LMC are as far from reality as Jeremy Hunt is from the NHS. If NHS goes to the salaried model, they would collapse within a week. Sickness, defined hours, defined paperwork, defined home visits etc. They still don't realise partners are the cheapest workforce. Don't get me wrong- I would happily give up my partnership and become a locum- earning 100 pounds per hour, when the system is in desparate need for GPs, for the work leftover by the SALARED GPs.
    I'm sorry, I might be out of work- because when the private compaines take over, with Hunt as their MD- they won't give a s**it about the patients not being seen.
    I'm worried and so should the people be- Only one thing left to say if it happens- Australia- here I come.

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  • Way to go. Ask your local CCG what it is paying interim managers. You may well find it is much more than you earn. Because they are in short supply, they charge the Earth and the NHS pays it.

    Ditch the contract comrades!

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  • @ Anon 5:18

    £100/hour + is what I currently charge and im fully booked for three months. Wake up and smell the coffee people! Simple maths, one partner quitting= work for 3 or 4 locums. Dont listen to your fear of the unknown and oh continuity of care shit and just DO IT.

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  • Lol at "continuity of care" (6.50)

    I hate continuity of care. Yet more BS sold to us by our seniors. Along with the c**p about how home visits are great because you get to see how the patient lives.

    Continuity = Heartsink I could do without.

    Has anyone seen my cardigan? I seem to have mislaid it.

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  • This won't change a thing ..its window dressing
    General practice is under funded, over stretched and dumped on by anybody and everybody

    A turd on a plate with a salad garnish is still a turd

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  • Anon@7.03
    Continuity of care is valued by patients (once they find a doctor in whom they have confidence, of course) and enables more effective use of GP time because you don't have to start from scratch with every patient at every consultation. Moreover, a build-up of trust means that patients are more likely to accept advice/diagnosis having been treated well in the past and the doctor is in a better position to assess likely significance of woolly symptoms.

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  • 5:18PM you are wrong. Hospital staff are salaried too and work well beyond their duty of care to make up for the shortages. Working as a salaried GP is the same - you act like a buffer.

    The only way you will truly be in-control of your workload is when you set the terms i.e. locumming.

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  • BTW - I support a fully locum GP profession.

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  • With the amount of responsibility and liability resting in the GP sector, it would be too toxic for the government or indeed large private providers to take a bite out of.

    I think this motion input forward by some old cardigans looking to inflate the value of the premises they own upon their retirement.

    If think if the GP's do go salaried, there will be a lot of fun to be had for people who actually know how the system works from the inside.

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  • @ Anonymous | GP Partner15 Jan 2016 8:37pm

    Thanks for the lecture. If you hadn't realised I am not interested in these clichés even if there is some validity in them. I have been practising for over 15 years and can draw my own conclusions.
    So called continuity has many facets in General Practice including cosiness and cronyism which lead to GP compromise, favouritism, inequity and a lack of objectivity. It often means that patients keep seeing the same doctor in the practice because they like them, regardless of other expertise that other doctors have in the practice specific to their needs. Worst of all is the doctor dependency “continuity” brings which often suits certain patient and doctor types who end up meeting regularly and achieving little or nothing other than some sort of emotional fix.
    Yes, continuity for a particular episode of care has some benefits but on balance I can live without it thanks.

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  • Anon 9.09am
    You are confusing continuity with co-dependency. For sure one can lead to the other but it is not inevitable. I am militant about avoiding the types of cosy set ups you are referring to but also believe that continuity is the bedrock of general practice. Go figure.

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  • Anon@9.09
    What clichés? Not intended to be a lecture - just another point of view - but if you indeed have 15 years' experience, perhaps you didn't realise how you came across either. It may be that your second post reflects your own experience but it is not mine and is certainly not what I mean by continuity of care.

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  • To the last two comments:
    Ok well since I no longer have a flock to look after I really don't care about continuity. In, out, shake it all about, one session at a time. No pathology results, no hospital discharges with do this and do that, no PPG, no social services reports, no Atos forms, no CQC, no Gold Standards meetings, no meeting my local community pharmacist, no NHS Choices slander, no wondering if I will ever get paid for LES and DES….. need I go on?
    I thought I had joined a profession, not a monastery. I do the job for money and not love and before anyone starts berating me for saying that, maybe look up the word professional and see what it means.
    I will keep working in different practices which need my services because they can't find partners as increasingly, people like me, who feel they have been exploited enough, are now in mercenary mode.
    So thanks for the semantics Nabi, but you haven’t changed my mind.

    Keep kicking your dog and eventually it will bite you.

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  • Sorry I meant to say your first name Shaba, not address you by your surname. No offence meant.

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  • @ 1:17 hear hear

    It takes me 2 munutes flat to look at the notes and...ta daaa continuity of care done. If a patient is truely unwell or in need of help then all they want is to be sorted out, not a blooming relationship. Truelly unwell patients also tell the doctor everything and dont play games-lets see if this one can read my mind..bullocks. Time to get rid of the pseudo-patient.

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  • Turkeys will be asked to vote for Christmas.
    And any turkeys stupid enough to vote for a life as a salaried serf deserve everything that will happen to them.

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  • To Anonymous | GP Partner16 Jan 2016 2:37pm

    Presumably this is the opinion you have of all the staff - sorry "serfs" who work at your practice. Nice.

    Better to be a salaried serf than a peasant master. I know plenty of partners whose salaried and locum doctors now earn more than them for a lot less effort.
    The real turkeys voting for christmas are the partners who are joining federations. They are paradoxically forming groups in order to retain their autonomy when the government has already said half of GP contracts with be gone in the next 4 years anyway.
    Talk about head in the sand.

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  • Anon@1.17
    If that's the only part of the job you are able/willing to do then fine but you do actually depend on those you are deriding picking up after and around you, doing the whole job, not just the parts that appeal, being around to employ you and willing to accept your approach to the work.

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  • @ Anon partner 4:33 pm

    Thank you master for your generocity. Please continue to bust a gut a become mentally unwell cause otherwise us poor locums would be on the bread line.

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  • The more I practice the more I feel that continuity is seriously overrated.

    half the reason that general practice is in the hole its in is that GPs are too willing to bend over and absorb all the additional crap in return for better continuity.

    the whole idea of continuity is a massive con that only serves to emotionally blackmail GPs to do extra.

    And yet we pray at its altar like the sacred cow that is free at the point of entry.

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  • I think most GPs are just in complete denial that the game has changed. Patients no longer care about 'the doctor patient relationship', they only care about what they want and only act how they do to get it. They are only out to get what they want and have no respect for us, even the ones that say or pretend they do- why else would they demand home visits when they are perfectly able to leave the house? Why else demand appointments immediately for trivial nonsense? And these are the ones that pretend to respect us.

    If they respected us they wouldn't do these things.

    as others have said, continuity of care is just another word for dependency. You get continuity of care by actually reviewing notes and not by simply knowing the patient for 30 years. Yes it's easier to say no to a drug seeker if you 'know them', but then it's not really that hard if you just say no and stick to it and they will leave.

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  • Too much tree hugging nonsense in general practice. Continuity of Care is over rated.

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  • The BMA Salaried GP scale is £55412 to £83617, model GP contract. However the consultant scale is £75249 to £101451 with a top up excellence award of between £2957 and £75,796. This to me means an actual pay scale of between £55412 and £177247. Please correct me if this is wrong. If you look at press releases consultant pay can be much higher than this.
    Why can’t a Salaried GP force have the same consultant pay scales?

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  • To the last few comments- Some of you have touched on the crucial issue which is the notes. "Continuity" best suits those doctors who keep such poor medical records that only they really (if they can remember) know what is going on.
    I have worked with these doctors. They are often well loved by their patients but keep inadequate notes, take weeks to deal with admin and seem to almost enjoy the chaos which they create by their selfish ways of working. Perhaps it boosts their ego and makes them feel important as they know people just have to work around them and make allowances.
    Anyway if we are (and we are!) going to have 8-8, 7 day working, continuity will go out of the window. We will see increasing cross-cover and hub working. Only by sharing the record can this be achieved and I am already watching the panic in my locality of many of these rubbish doctors who refuse to share the record and are desperately trying to use patient confidentiality as a reason to protect themselves from the scrutiny of colleagues. It will be interesting to see how federated colleagues deal with the situation where they find substandard care. Let’s see candour and transparency at work!

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  • Having read the above comments - I for one can't wait for the day the current massive need for locums comes to an end. And before anyone bleats- I know that will be along time coming with current mantra of it's all about "supply and demand, dictated by market forces" blah-dee-blah-dee-blah.

    It would seem that locum work is the 'dependency' that many GPs are being fed is the way to a utopian existence. In fact in our present predicament it is just the outcome of dysfunctional system. If we all decided to 'do it solely for the money' and forget about the silly bits like 'admin, meetings, pathology results' why not train to be a banker, and be a first aider at weekends. I would have said paramedic or A+E doc if 'whizz bang wallop, in and out' is what medicine should be for you, till I remembered that silly bits like 'admin, meetings, pathology results' is part of their responsibilities too!!

    To some continuity of care has a purpose, to others clearly not. Each to their own, but it seems that we are in danger of throwing the baby out with bath water if attitudes persist that this fundamental aspect of GP'ing is diminished in the quest to 'earn a few more bucks'.

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  • WHAT A MASSIVE CARDIGAN.

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  • Anonymous | GP Partner17 Jan 2016 12:23pm

    I am one of those mercenary locums who you might think does not want to do the extra stuff. I do not consider these items of work to be silly at all. Quite the opposite in fact. I object the complete lack of recognition of the massive workload all these bits represent and the fact that partners are not properly remunerated for them. If someone wants to pay me to do their repeat script reviews or sort out their admin then I'm good to go. The trouble is that nobody in power or leadership seems to place appropriate value on this work which they trivialise.
    I am genuinely sorry if, as a partner you feel got at by people like me, it is not my intention. It is just that these extra tasks are almost exclusively associated with the drudgery that partnership entails.

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  • Society has no more good will. And why should it when resources are overstretched and the most trivial nonsense is medicalised?

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  • Its those cardigan wearing pseudo-martyrs that we need to get rid off.

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  • No we don't want to get rid of them at all. We need a few people who wish to fight to the death. Who else would be prepared to be the last man standing holding the obsolete 25 year lease and paying the staff redundancies?
    Just watch, the next 3-4 years will be a competition to see which partners can jump ship the quickest. Its like a game of pass the parcel with the prize being bankruptcy.
    Your turn...

    Ditch the contract comrades!

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  • To
    Anonymous | Sessional/Locum GP|17 Jan 2016 12:30pm & 2.12pm

    if giving your 80 year old plus mother/grandmother(any relative actually) with multiple co-morbidities the time of day and treating them as holistically as individuals and not as some transactional commodities their only for you to 'earn a few more bucks' is being a cardigan then so be it. I'll wear the badge with pride.

    I definitely wouldn't want my beloved ones being treated by NON CARDIGAN MECENARIES only in it for the 'wonga', continuity of care be damned. (And for those who may not have worked it out yet - being able to read a patients notes DOES NOT equate to continuity of care, no matter how much you might want to perpetuate such a stupid notion to imply a sense of professionalism).

    But hey, I might be wrong there too, after all I am a CARDIGAN??!!

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  • anon partner at 9.16

    hear hear.

    It is the elderly and rail and complex patients who need continuity because you can't possibly get a full assessment of a person in a single 10 minute consultation.

    All very well to talk about continuity for a single episode or singe problem, but for these patients there is no such thing as a single episode or a single problem.

    Fair enough for those who don't come to the docs often and who don't want a particular GP. Happy for them to see anyone, and they will be happy to see anyone.

    But the joy of this job comes from making difference to people, which only really happens if you can see them as people. And that is so much easier if you have a bit more background about them.

    Proud to be a cardigan here.

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  • I'd say freedom from serfitude, not wanting to feel exploited by another and yes the wonga, do motivate most GPs, it's a fact. I can't see how an all salaried contract sorts out any of those.

    Quick word for the cardigans, take back OOH for your patients and I'll give you the proper credit. Otherwise you're just creating a nightmare for others.
    I got called out at 10.30 pm on an OOH shift last month by a bloke who insisted (as he was going to the outpatients that week) I write out a letter to expedite his hernia surgery. I had some choice words about using OOH services appropriately for him, but he confidently announced to me I was the one acting unreasonably and that his doctor "would have done it".

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  • To S.K.S
    "I'd say freedom from serfitude, not wanting to feel exploited by another and yes the wonga, do motivate most GPs, it's a fact"
    Your point being...??

    Let's see, hmm...

    "I'd say freedom from serfitude, not wanting to feel exploited by another and yes the wonga, do motivate most bankers, it's a fact"

    "I'd say freedom from serfitude, not wanting to feel exploited by another and yes the wonga, do motivate most criminals, it's a fact"

    "I'd say freedom from serfitude, not wanting to feel exploited by another and yes the wonga, do motivate most lollipop, it's a fact."

    Oh I see - not being in servitude, not feeling exploited and wanting wonga is a god given right for only GPs. as a group of workers, to expect/demand. Is that what you mean? And I take it that you feel as a result of this injustice that GPs should have no sense of professionalism towards patient care because you want to stick it to the boss man.

    And what providing OOH care for acute problems has to do with providing continuity of care for patients with LTCs. only you know. Note the difference between acute (needing to be seen urgently) as opposed to chronic (ongoing management over time).

    Trust me a cardigan would not be seeing let alone writing a letter for any patient at 10.30pm to expedite hernia surgery or any other obviously inappropriate request. We cardigans do have some discretionary judgement you know, despite what some might say. But then again a cardigan probably isn't so "wonga" hungry to be doing that OOH shift in the first place!!

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  • Oh thank you SKS! How true.

    OOH. Three letters that test the conviction of the holy cardigan.

    Hey 9.16, you might not like me treating your granny (with my mercinary, give real treatment rather than charming this old dear into thinking I am actually providing her with decent care when all I'm doing is fobbing her off with a kind smile and s**t treatment, fangle dangle evidence based ways) but lets face it, who else is going to, when you abandon your alturisitic post at 6.30pm?

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  • "joy of this job..."
    Is this some sort of joke?

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  • Oh Anon 11.02pm surely you mean the
    OOH - three letters that define the 'mercinary' who don't give a xxxx types who for some reason believe only they work beyond 6.30pm. You might be interested to ask some of your colleagues whether they work day shifts also, unlike 'mercinary' types, wonga-seekers, and Hunts new breed of 'greed is good' GP.

    And I do not stand corrected, I would rather my granny be treated by a multitude caring and compassionate health care professionals that do still exist and work for the sake of their patients not their wallet. I'll let you into a little secret - they do what you can't, won't should; despite what some self aggrandising egos might believe about their own importance.

    CARDIGANS OF THE WORLD UNITE!!!

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  • They do what I can't. Hmmmm and how did you reach that conclusion? Please if you cardigans are going to unite, don't follow 00.01 - what a lacking in logic, fool.
    By the way if you want granny treated by these saints, please ensure she becomes ill between 8am and 6.30pm because although the cardigans may be working outside of these hours, they will be consumed by admin and unable to deal with her. I used to be a partner and was so for many years. So if 11.02 thinks he or she is somehow coming from a higher moral standpoint - wrong. Give up. you are living in the past. You are being exploited and you just cannot face this reality. Evil people mug off good people. That is the law of the jungle we live in. Grow up and mature from your public school, head boy, naivity. The world is a nasty place.

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  • Cardigans of the world, please flush the chain on your way out.
    Thanks

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  • Oh yeah and the little secret you let me in on - I didn't want you to share your BS in the first place so please don't think you are doing me a favour. Keep it to yourself.

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  • CARDIGANS OF THE WORLD - BUTTON IT!

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  • Don't blame LMCs, blame yourself for electing your beloved glib talkers as members of this institution who are now preparing an enema for you.

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  • As a retired former hospital doctor, partner, sessional GP/locum , salaried GP and OOH provider I frankly wouldn't want to be treated by any of the bickering twits that have contributed to this debate thus far. What a bunch of snivelling self obsessed individuals you all are! You have a damn good job with a pretty reasonable salary regardless of how you get paid, and it you don't like it - leave . You do have a choice you know!

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  • "Cardigans of the world unite"?

    -That's exactly the problem - they don't. They drift along doing what THEY think is right and refusing to see the need for anger or change or confrontation (with patients or with politicians) and think that by shrugging and saying "n'kay" they are providing an altruistic service.

    We would be in a much better position if such people grew a pair and stood up for a decent service that could be sustained, and not just giving in to whatever bull scheme that the administrators come up with next, or every demand their patients throw their way.

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  • I will wear a cardigan if I'm paid enough. Size does matter when it comes to the salary . So how much are we talking about ?

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  • Not enough that's for sure .100/hr @ 30 / week = 150k . Like that's going to happen .

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  • Suggest asking anyone who has worked as a GP for Virgin about how that went if you do not understand why this is a Very Bad Idea.

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  • @"Salmon | GP Partner18 Jan 2016 11:36am

    Suggest asking anyone who has worked as a GP for Virgin about how that went if you do not understand why this is a Very Bad Idea."

    I'm going to the conference in a fortnight and I'd be keen to hear salaried testimony actually. I don't yet know how I'll vote on this. Do salaried GPs in big organisations have more stress or less than their independenat contractor colleagues? What about workload/work-life balance/admin/freedom/integrity?

    I've only ever been a Partner so I'm interested to hear about life on a salary. Personally I would love to know how much money I'll have each month for starters.

    I don't think it boils down to choice of knitwear though ;-)

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  • According to the retired doctor who is hanging around here because we are interested in some has-been's opinon, we are twits who he/she would not want to be treated by. We are also reminded that we can choose to leave.
    Well you are retired which means sooner or later your health will fail. I wonder if you will be quite so dismissive when that day comes.

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  • To 11:01pm

    ''Trust me a cardigan would not be seeing let alone writing a letter for any patient at 10.30pm to expedite hernia surgery or any other obviously inappropriate request.''

    Unfortunately this is EXACTLY what you cardigan types have been doing. All this 'holistic' nonsense has generated inappropriate expectations.

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