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Lord Darzi: All GP partners should be offered salaried NHS employment

All existing GP partners should be asked if they wish to become employees to the NHS, influential NHS policymaker Professor Lord Ara Darzi has said.

Lord Darzi, a former Labour health minister, said this comes as independent contractor general practice has in some cases hindered the move to primary care at scale.

Following a review, the Imperial College London professor has set out a 10-point plan for the NHS for the 2020s, in which he said general practice was the ‘jewel of the crown’ that must be protected.

As part of this, he said the total NHS expenditure towards primary care, community care and mental health should increase each year to 2030.

His recommendations come ahead of the Government’s own long-term plan for the NHS, due out this year, which will be underpinned by this weekend’s announcement of a £20bn five-year funding increase.

It also comes as the Department of Health and Social Care has launched a review into how the GP partnership model can be 'reinvigorated' to attract and retain more GPs.

Lord Darzi’s report, published by the Institute for Public Policy Research, said that leaving general practice 'in the private sector' has 'in some cases (but not all) - made it harder to move to primary care at scale at pace because it requires small organisations to take on big contracts or come together to form partnerships'.

It said this had 'also put more pressure on GPs – to run a business as well as provide medical care – with levels of stress and dissatisfaction in the UK disproportionately high compared to other countries'.

Lord Darzi went on to say that ‘while some think the partnership model is ideal and will want to retain it, it is not right for everyone’.

And, referencing a Pulse survey of GPs from 2016, the report said: ‘More and more GPs do not want to become partners because of the levels of responsibility and financial risk involved in it as well as the geographical immobility it requires. Evidence suggests that many GPs would be open to moving to a salaried model.

‘That’s why the NHS should welcome general practitioners into the health service, as full employees, on the same basis as their colleagues in hospitals.’

Lord Darzi suggested that ‘this could occur as part of a transition to Integrated Care Trusts’, adding: ‘All existing GPs should be offered salaried employment for their core clinical services. Those that wish to retain their existing contractual arrangements should be allowed to do so – this is likely to be particularly important in rural communities, for example.

‘Overall, these changes would remove the risk and stress that currently exists for many general practitioners.’

The report went on to recommend that general practice nursing, clinical and administrative support services should be funded on a capitation basis, while new funding streams are added to proivide enhanced services 'to sustain the entrepreneurial and innovative characteristics of much of general practice’.

The Pulse 2016 survey of GP partners referred to in Lord Darzi's report saw just over half (51%) saying they would consider a salaried position 'if offered the right deal', and 36% saying they would not.

But in an updated version of the survey, carried out in April this year, the numbers who would accept a salaried role declined marginally to 50%, while the numbers who would would not accept a salaried post went up to 40%.

Commenting on Lord Darzi's recommendations, BMA GP Committee chair Dr Richard Vautrey said: 'This is at odds with the partnership review commissioned by the secretary of state for health and social care and it is that which we will be engaging in.'

Dr Zishan Syed, a GP in Maidstone and Kent LMC representative, said: 'My view is that it is not the independent contractor model that needs remedying but rather the mechanism of funding. A fairer method of funding primary care that gives GPs adequate renumeration like the Australian/New Zealand model would be ideal. 

'The present obsession with pursuing "salaried for all" serves the interests of a few individuals who often are barely involved in frontline care and would happily exploit others with very poor salaries and poor continuity of care for patients. The purchase of all the premises from doctors would be prohibitively expensive.'

The report also recommended abolishing CCGs, replacing them with 10 strategic health and care authorities; merging NHS England with other arms-length NHS bodies including Health Education England; ending compulsive competitive tendering in the NHS; and offering free fast-track British citizenship to all EU citizens currently working in the NHS.

Lord Darzi was a health minister in Gordon Brown's Labour government between 2007 and 2009, when he resigned from the role. He will be most well-known to GPs for his policy to roll out walk-in polyclinics - dubbed Darzi centres - in all areas of London.

Lord Darzi's recommendations for general practice

  • Establish a new ‘right to NHS employment’ for all GPs currently working for the NHS.
  • Allow all existing holders of General Practise contracts (GMS, PMS and APMS) contracts to continue to under these arrangements, if they wish.
  • Create new funding streams to support innovation and enhanced services.
  • Increase the share of total NHS expenditure that goes towards primary care, community care and mental health each year to 2030.
  • Design care around groups of people with similar needs rather than around groups of professionals with similar skills.
  • All people of working age should be offered the option of digital consultations with in-person appointments available via easy access facilities at 24-hours’ notice, with access at the weekend and in the evenings.
  • All people with one or more long-term conditions should have a single care coordinator, a co-produced care plan and longer routine appointments with the GP by 2022.
  • People with serious enduring mental illness should have routine physical health care available at their homes by embedding GPs in community mental health teams.
  • Every neighbourhood in England (25,000 to 100,000 [people]) should have access to a purpose-built multi-specialty integrated care facility with embedded diagnostics by 2030.

Source: Better health and care for all - a 10-point plan for the 2020s

Readers' comments (56)

  • I await with interest the suggested salary!!

    I have been a partner for over 20 years (leaving next week...) and in my humble opinion a profit sharing partner is worth their weight in gold with all the goodwill that they invest into their business AND the NHS.

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  • Hmm, let's ask a tertiary centre specialist surgeon with an interest in robotics to reform primary care.

    They could not have found someone more removed from coal face General Practice if they tried.

    Remind us: how did the whole Darzi Centre thing play out?

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  • So if a full time partner is working 50-60 hours a week, and a full time salaried GP is 37.5 hours, where does that additional work force pop up from?

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  • I'll take a salaried role at the local Darzi centre.

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  • 500k-for each nurse for starters- thanks
    You don't need so many managers to manage dwindling numbers of nurses and doctors......plan's working- churn the tax money through to our PFI and manufacturing chums, oh and the valuable gauleiters like the CQC

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  • 'Offer all partners salaried GP employment.'
    Great idea! But hang on...
    What happens to the costs of/buying out of:
    premises (including branch premises)
    existing staff (especially the responsibility for severance payments)
    ongoing contractual requirements in leased buildings and PFI buildings
    existing ongoing contracts (telephones, IT, vehicles, equipment)
    .. and how does this fit in with private work done at these establishments, or buildings which are privately owned which are sub-let to other healthcare professionals?
    What about those who still work from premises in or still attached to their own residence?

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  • Vinci Ho

    Show us the terms and conditions before any further discussion, full stop .

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  • Probably being thick, but which bit of the single care coordinator role couldn't be done by personal list GP?

    How does he plan the digital consultations in areas with poor broadband connection/service?

    Also could the purpose built multi-specialty integrated facility be a DGH???

    I assume these individuals he needs will be falling over themselves with offers like "NHS employment rights." Just ask my wife following her return to work arrangements after a slightly inconvenient (mostly to NHS that is) appendicectomy!

    I count the minutes till I can stick the finger to the job with minimal impact to my pension, I envy JP!

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  • Dear All,
    The once polished and cherished privately owned car is jerkily coming to a halt at the roadside for lack of fuel and servicing. So rather than change the oil and filters and pour in some fuel, lets send them the state owned utilitarian rescue bus for them to climb on board.
    Then we can laud how everyone "wanted" to join the merry crowd on the charabanc.
    The wilfulness is cringing.
    Paul C

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  • Peter Swinyard

    Well, I won't be telling him how to organise a tertiary care bowel surgery department. Perhaps he will offer us the same courtesy. Perhaps he has been at the tail end of medicine so long that he has developed coprolalia.
    If he seriously thinks that removing the partnership model will "invigorate" the entrepreneurial nature of general practice he is 180 degrees in the wrong direction. Let us see what the good Dr Nigel Watson comes up with in his partnership review due to report finally in December with an interim report in September.

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