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A faulty production line

Relinquishing independent status would 'emasculate' GPs, says GPC

GPs would be told how to treat their patients by the state if they were to give up their independent status, says a GPC negotiator in response to a call from Professor Clare Gerada yesterday for the profession to become salaried employees of the NHS.

Dr Peter Holden said that GPs represent the last group of medical practitioners not to be ‘enslaved by the NHS’ and that removal of their independence would ‘emasculate’ the profession and hamper recruitment.

RCGP chair Professor Clare Gerada called for a historic re-evaluation of the independent contractor model of general practices in her final address to RCGP members at the college’s conference yesterday in Harrogate.

She said that the time of GP practices working in isolation ‘has passed’ and called for a move towards provider organisations led by GPs to reduce fragmentation of care and reduce costs.

But Dr Holden said that he fundamentally disagreed with Professor Gerada and warned it would harm the doctor-patient relationship.

He said: ‘I disagree, and one of the fundamental reasons I disagree is the same reason our grandparent’s generation disagreed in 1947. If the state controls the profession it controls what is the best advice to the patient.’

‘The bottom line is that our grandparents generation had it right, and the reason why there was such resistance was because they did not believe that the state would not interfere in the doctor-patient relationship – and I think that the antics of recent years proves that to be true’.

‘It is time people realise that medicine is not the NHS and the NHS is not medicine, and the last significant group not enslaved by the NHS are GPs.’

Asked what was the worst that could happen if GPs lost their independent contractor status, Dr Holden said it would be the Government dictating how doctors treat patients.

He said: ‘We would be told how to treat patients. We would not be able to speak out on the patients’ behalf. It would emasculate the profession. At the moment, if I believe something is right for patients, provided my peer group agrees with me, I can do what is needed.’

He added: ‘I have no desire to be anybody’s employee and I never have had. That was part of why I chose general practice. I am freer to organise things the way I wish to organise them, yet still give patients a cracking service. I went to the Frank Sinatra school of medicine – My Way.’

In the face of calls from Professor Gerada for 10,000 more GPs, Dr Holden also said her suggestion would hamper any drive to increase the GP workforce.

He said: ‘I think there would be fewer people becoming GPs. Because actually there are a proportion who once they have seen the freedom of being an independent contractor, actually they are quite attracted to it. I think that you will get a proportion [of graduates] entering the NHS, and a proportion who just emigrate - and if I were a young man, I would just emigrate.

However, he added: ‘But if you wish to salary me, that is fine. I will not be in on Monday morning with my sore throat and I will walk off the job at 6 o’clock even though the waiting list is full.’

‘I feel quite strongly that the Government doesn’t realise what a bargain it has got.’

‘You have to remember that if you are an independent contractor your job description is task-delineated. If you are a salaried employee, your job is time-delineated. That means that you will underbook, you will not get the through-put that we deliver. I think it would be disastrous for patients.’

Readers' comments (32)

  • Bob Hodges

    I became a GP precisely BECAUSE I didn't have to be salaried. What Clare is suggesting is actually the ONE thing you could do that on it's own make me emigrate.

    I've not had a day off sick since become a partner 2 years ago. I'm also more 'stressed' than most of the people I sign off work for being 'stressed'.

    Is Clare spotting the connection between salaried status and attendence and hence workforce availablity?

    Or is she suggesting we all be given Zero Hours contracts...........

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  • It's not the model that's broken, it's the funding. GPs are seeing more patients than ever despite a 7% cut in resources. The government still has a bargain but you just have to look at the value they placed on out of hours to realize that no-one in Whitehall gets it. Going totally salaried really is a race to the bottom that no-one wants to enter.

    We keep getting all these central diktats from up high yet not one of them has worked - 111,MMC,revalidation,CQC,monitor,CCGs; these have all made things worse bar none, when will they learn? I just wish the government would leave us to get on with what we do well, that is look after our patients without outside interference.

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  • Is Clare's proposal even legal?

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  • I tell medical students and registrars that the reason GP partners get paid so much money is that they have the duty to deliver a service regardless of the pressure, the knowledge to deliver a decision regardless of the circumstances and the confidence to present a suitable solution to a problem where there is no clear answer.

    If those challenges are passed onto a manager, business or the wider NHS, we end up with North Staffs Hospitals, 111 triage and a terrible OOH.service

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  • So all hospital consultants, nurses, and other AHPs are emasculated puppets of the state are they? Motivation comes from more than profit margins.

    Sadly, such breathtaking arrogance from a morally bankrupt profession is what I have come to expect of GP 'colleagues'.

    As a salaried member of staff, I have had two days off sick in 10 years (when my leg was in plaster) and work longer hours than most of you.

    We don't care whether you wish to keep your independent contractor status or not, just stop insulting the rest of us, who work just as hard for our patients, and under just as difficult circumstances, but on a salary.

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  • "As a salaried member of staff, I have had two days off sick in 10 years (when my leg was in plaster) and work longer hours than most of you. "

    I call BS. You wouldn't be able to work more than most GP Partners due to the EWTD. At least be honest.

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  • Well said Peter.It would appear the majority of GPs would agree with you rather than Clare.The RCGP does not represent us in negotiation, and I feel let down by them.The goverment is using their face to represent us, when it does not, purely to pursue their own agenda.
    As to workload, I remember the on- calls, 80 hour weeks were the norm, then the new contract shifted work to the day time. 80 hour weeks are now back, but not the at home, waiting for a call type of duty, but exhausting full on days that for myself is 8 til 8 already.
    I became a GP so I had control of my working enviroment, and at least in my practice the ability to make a descion on providing a pleasant enviroment for my patients and staff, even if it reduces my take home pay.Consultants lose that , unless they have private rooms.Or is that the agenda here?

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  • Azeem Majeed

    My editorial in the October edition of the Journal of the Royal Society of Medicine discusses the current capitation-based funding system for general practice and why it is time to consider modifying it in favour of methods that link workload more closely to funding. The full text of the article can be viewed at:

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  • its all about privatisation ...make everyone slave to private companies ...

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  • Vinci Ho

    Truth is :
    Everybody is talking about the same thing-'overworked , under-resourced and underpaid'. Does not matter whether you are partner or salaried, mate.
    What makes you think another 'new' system where everybody is salaried , then you would not have this same problem of ' overworked and underpaid'???
    The bottom line is whether you are giving more chance to the government to manipulate our profession.
    As I said before , if you somehow still have trust and faith in the government , go ahead , mate . But I wish democracy is still respected for all colleagues to have a say on this , President CG........

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