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At the heart of general practice since 1960

No amount of perks will persuade GPs to settle for salaried posts

Hull’s salaried GP recruitment scheme won’t work because GPs will always want independence, writes Dr Zoe Norris,

Hull, where I work, has been hit particularly hard by the GP crisis. If I talk to anyone working in my area their stories all speak of the same stress – ‘no applicants to our BMJ advert’; ‘can’t replace a retiring partner’; ‘at least eight sessions short’; ‘had to close our list’. It’s not rocket science as to why this is the case - the major issue locally is loss of retiring GPs and poor recruitment of new colleagues. The local VTS has only filled 11 places out of a possible 30.

Our CCG believes the problem can be solved locally with a solely salaried model, extended fixed term contracts and added incentives of training opportunities and professional development. The long-term aim is for the city to be served by a purely salaried service.

But despite the perks, this is still a tough sell. Both new and existing doctors are sceptical about how the scheme would work. Few groups of incoming GPs would choose a six-year contract in such uncertain times. And candidates are unsure if the remuneration will be competitive against a nationwide market.

At the same time, local partners are concerned about the impact of the proposals on their staff and premises, and feel unsure of how the model would work. They are also worried about the possibility of outside-area providers or private companies becoming involved, as co-commissioning looms.

Yorkshire Gold

And despite the crisis, GPs can still work in Hull without signing a six-year contract.

I’m a locum as part of a medical “chambers” organisation, which provides regular group and peer support for locums. Doctors in chambers pay into their group to fund a small management team, who arrange bookings, negotiate work, promote the service, and generally handle the business of being self-employed whilst the doctors get on with the doctoring. The Yorkshire area has thriving GP chambers in Harrogate and Leeds as well as the one I’m in, which covers York, the East Riding and Hull.

This model of locuming provides me and my colleagues with a flexible career, but with the support of something bigger.

Rather than all becoming salaried employees, GPs could retain their independent status while being part of an organisation that brings its own benefits. The NHS is changing, and given our often lacklustre representation at national level, it’s time to take matters into our own hands.

And Hull is a great place to work for new GPs. The establishment and work of the Hull York Medical School (HYMS) in 2003 has brought huge benefits for the local doctors, offering training and teaching opportunities, as well as furthering education and research in the area. Considerable work has been done to encourage engagement between primary and secondary care locally, and excellent community matrons and nursing teams support general practice

Property prices are low, but the villages surrounding Hull and the nearby town of Beverley offer plenty of choice. Road and rail links to motorways and mainline routes make getting around easy. Plus the seaside is nearby, and who doesn’t like a bracing stroll near the North Sea with the promise of a chip shop at the end?

Granted, fish and chip suppers might not solve the local recruitment crisis. But while the government still refuses to give our profession the support it needs, they’re a far more appetising prospect than being a salaried GP.

Dr Zoe Norris is a GP in Hull. She recently wrote about working as a GP for the Huffington Post.

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Readers' comments (30)

  • I think this will be the future,we will be independent and the employers/commisioners/government will be pay market rates.This is alll about the supply/demand curve but the civil servants+politicians seen too dim to realise market forces worke both ways.

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  • If I may add, no young GP in his or her right senses wants a Partnership.

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  • When the NHS was founded, it had huge opposition from GP's because they were concerned that they would become salaried and in effect civil servants.
    I will be very sad to see their fears come true.
    I believe the country gets the best value from the independent contractor status.
    I fear that if we are salaried, many GPs will simply set up private practice.

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  • Vinci Ho

    I think clearly the word 'independence' stands up. Different regions perhaps need different arrangements but they have to circumvent this principle of independence. As I said to my local colleagues , the primary aim of forming a federation , if decided , is to protect the independence of individual GPs or sovereignty of practices within. Delivering more services or not is of second priority. Clearly , the picture of every new coming GP being salaried under some big 'organisation' on which one cannot influence is not healthy to me, an old dog still believing in GP partnership.......

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  • Re a salaried option, it depends on what the offer is. £120k per year, no management stress, personal lists, supported training, integrated teams etc etc? Whilst independent contractor status has served the profession well for many years, the crisis in popularity and recruitment in General Practice, the unremitting workload etc means we must start looking at options that will improve work life balance and stop GPs retiring in their droves.

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  • Working for GPs as independent contractors has been a nightmare for me as a nurse. I know there are fair and genuine ones, but I have only observed reception staff not getting breaks, proper pay rises, appraisals, holidays. Nurses often find GP partners refusing to allow training, correct grading. We have GPs not attending training yet they tell nurses to do things they are unqualified to do.
    A business has to earn it's customers, not be given a sum of money to spend as they please by NHS trained doctors, to NHS patients, using NHS trained nurses, yet they are not NHS. Very odd to me.

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  • GPs need to be careful of abandoning the patients and their profession by just being locums. Someone has to lead the true independent profession as partners and salaried in practices committed to their patients and the practice business. Locuming is ok as a short term option for a few. The future lies in leading and owning the ground and the business otherwise others, CCGs or secondary or community trusts may just do what Dr Norris fears.

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  • There are some truths here - Hull is a vibrant city and a fantastic part of the country to live and work in and has an excellent medical school. However it does have, without doubt, primary care workforce recruitment challenges. There are significant numbers of GP vacancies (with many practices looking for partners), the training scheme is under filled year on year and the city has one of the lowest rates of GPs per head of population in the country. The patients in Hull deserve committed GPs offering quality care, continuity, ownership and leadership. Unfortunately locums do not offer any of this and as a result risk letting down both patients and their profession. They offer a minimum level of service and charge high fees for their input, draining resources from practices that find themselves in a position where they need to use them. If GPs don't want to be partners or salaried GPs working in and committed to a practice and a population then surely that spells the end for primary care as we know it resulting in a poorer product for patients. CCGs are GP led and in the City of Hull the CCG does seem to be looking at all the options and trying to provide the opportunity for GPs to secure the future of primary care and deliver quality care to patients that have, according to public health statistics, greater healthcare needs than in most areas of the UK. Perhaps Dr Norris and her colleagues might one day commit fully to a practice and enjoy the privilege and satisfaction that comes with providing continuity of care to deserving patients

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  • 11.25 pm,To be able to commit to a practice you have to feeled valued by the system you are propping up.It has been evident over the last 5 years, that the Goverment/populace/media do not value GPs.As a young graduate Dr leaving University with approx 80-100k of studuent debt why would you commit to GP land at the moment never mind to this country.

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  • Hull is a dump.You will have to significantly adjust the offered salary upwards to get GPs applying.I would say at least £120,000/yr+extras

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