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Independents' Day

GP autonomy 'will be lost' under Scottish contract, warns former RCGP chair

GPs will lose their autonomy to employ and manage their practice team under the new GP contract, the outgoing RCGP Scotland chair has warned.

The new Scottish contract will see a number of healthcare professionals employed directly by the NHS, but attached to GP practices. The NHS will also pay expenses for all staff from 2020 if the contract is voted through by the profession.

Under the agreement, GP partners will earn a minimum of £80,430 by April 2019, and there is an intention that no GP will own their premises by 2043.

But Dr Miles Mack, who stepped down as RCGP Scotland chair this month, warned that the contract could lead to a loss of autonomy.

He wrote on Twitter: ‘The autonomy GPs have to employ and manage their team appears will be lost in the new #GPcontract.

‘We will be giving this up with no assurance on workload control and T&Cs far short of those enjoyed by Consultants. Seems odd…’

Local GPs have also warned that this could 'stifle' their autonomy. 

Dr Iain Kennedy, executive partner of the Riverside Medical Practice in Inverness, said: ‘We are successful and thriving despite the GP crisis, our income is better than average and our morale is very high.

‘We dread the thought of having board employed clinicians because we can’t even get our midwives to do flu vaccinations.’

Dr Kennedy added that the new contract ‘will stifle our ability to innovate and to change and stifle our enthusiasm and the talents of our staff’.

Dr Alan McDevitt, BMA GP Committee chair for Scotland, agreed that there will be less opportunity for entrepreneurial GPs ‘to some extent’ but insisted there is ‘no intention to destabilise practices’.

He told Pulse: ‘There are not a huge amount of practices in Scotland that have a huge variety of additional services. There is an expressed clarity you don’t have to be an entrepreneur to do well as a GP.’

But he added that there will still be some ‘additional services for GPs to choose to do’, such as contraceptive services.

Dr McDevitt also said: ‘Our perception is younger GPs appear to be more up for all the elements of [the new contract] because successful older GPs don’t have problems to solve.

‘This is about creating a sustainable model and it’s about how we survive.’

The contract will have a two-stage reform of the funding formula, with 'phase 2' offering a pay progession and a guaranteed income range – similar to that of consultants – from April 2020.

But the BMA and the Scottish Government have already said that they may have to adjust the contract as HMRC could consider the new model to be a salaried service.

GPs will be able to vote on whether to accept the new contract following a special conference for LMCs on 1 December.

The RCGP has been approached for comment.

Readers' comments (7)

  • Less than £40 / hour (before deducting tax, NI, indemnity etc), with imposed and likely demoralising terms and conditions.
    It doesn't matter how much work Dr McDevitt and 'the other side' put into the negotiations, 'a pig in a poke' is as described (or not).

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  • The problems are, static practice income, rising practice costs and patient demand. All the measures in the new contract don't really address these problems. A large increase in cash helped in 2004, that has been whittled away. GPs are, like the rest of humanity, are aspirational, we feel undervalued and demoralised, increasing workload for diminishing returns. If good value to be had for increased funding, give it to the practices, it would be disappointing to see it wasted on yet more managers to marshall the massed ranks of para-clinical workers. Mad idea but increased numbers of well paid GPs might solve the problem. I fear that Scotland is not far behind Northern Ireland, truthfully do not see what is being suggested will attract young docs

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  • Vinci Ho

    Forgive me for making a comment as an ‘outsider’ (GP in England).

    This contract , typically like Brexit, has raised more questions than answers :
    (1) The intentions of a new contract are understandable and logic to the current political climate. Indeed , one can argue this might not see the living daylights if there was a much stronger government in Westminster.
    (2) Clearly , the distinction between the definition of a ‘partner’ and a salaried has become blurring . What is the relationship of workload and the ‘guarantee’ of minimum earnings of 80,430 per annum? For an old dog like me , the word guarantee only raises more scepticism after these years(remember what MPIG stands for ?)
    If there is a minimum, is there a potential maximum as well ? For being a partner, there should be a gradation of more earnings for doing more on top of a fundamentally sustainable income. This flexibility is exactly what we ,GP partners in UK , had lost as government(s) managed to exploit and abuse the ‘loop holes’ in GMS (also PMS which is becoming history now) contract . It is funny that HMRC was ironically the little child who saw the emperor wearing nothing for his ‘new clothes’. Perhaps , a horse is a horse and a donkey is a donkey ,after all.
    (3) For younger colleagues, my question for you is whether you will just take this as another ‘job’ with a face value ‘salary’ of £80,000 and will attain a balance between life and work in your next 20-30 years?
    If there is ever a desire to work away from the environment in hospitals(which I will argue is equivalent to that in an ever expanding corporate company) , you may not find yourself running too far out?? Ultimately, terms and conditions govern and you are indeed allowed to say ‘No’s to anything in excess . Really ??
    (4) Then this leads to the question who are to be allowed to vote ? For those of my age (52) , a new contract is only meaningful for a few more years(no intention to be a schadenfreude) but it is the 20-30 year future of younger colleagues. I would argue all GP trainees should have a vote on this.
    (5) Amendments should be introduced into this draft before allowing you guys to vote upon . In addition to address the above questions ,indemnity and (to me) continuity of care should have some imprinting on this contract.

    Being a fan of Orwell and Einstein , you have to excuse my philosophical crap :
    The theory of special relativity states , whether you are inside a fasting moving vessel like a rocket (our youngsters) or being slower and stationary on the ground(old fart like me) , the law of physics( the law of caring patients , for us) is invariant..........
    The faster you run , you gain more mass and heavier (E=mc2) . Nobody or nothing , therefore, can be faster than the speed of light........(unless one wants to turn to the dark side where light cannot reach).

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  • Lots of things pay far better and have far better terms and conditions. As a profession, we have done our bit for the NHS - and it's rather sad the NHS hasn't done right by us.
    My advice to all GPs would be to consider working part time, to diversify into other (often private) areas, or retrain.
    Do not, under any circumstances, find yourself wholly dependent (either personally or as a practice) on NHS income and the whims of your CCG/STP.
    My dental hygienist charges £135 for an hour of her time, operating with little or no clinical risk and working 9-5 at low intensity.
    Why have we fallen so far?

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  • DT we have indeed fallen far. Agreeing to everything and one sided rule/contract changes. NHSexit is best for us.

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  • Heading in the wrong direction I’m afraid. The response to a lack of GPs is to create jobs for people who also do not exist. And be managed by the local Health Board. OMG, I could not come up with a better recipe for chaos. How about extra money for more GPs?
    As for today’s letter promising financial stability- it does nothing of the sort, and I feel we have been misled.

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