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Gold, incentives and meh

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’m opening up a private practice for glaucoma and MS sufferers. Anyone wanna join me? ;)

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  • Ask a super specialist surgeon born in Iran and trained in Ireland how to reorganise primary care in the NHS - destined to fail (just like his last effort) !

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  • Let’s pretend the problem is a simple one, then we can pretend the solution is a simple one! Trebles all round, then back to the private clinic!

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  • This comment has been removed by the moderator

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  • Great he’s at it again!!

    We all remember what happened to the Darzi centres!!!

    It is not primary care that does not innovate but the hospital and foundation trusts who are more interested in tarrifds and increasing income

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  • I listened to John Humphrys' interview with Lord Darzi last week and found myself in disagreement with almost everything he said.

    His views come across as anachronistic and out-of-touch with reality as those of the rest the Blair regime of which he was a part.

    When he declared that he was a "doctor not a politician" I nearly choked (BBC podcast @ 5:51).

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  • anon 2016, we could use our LMC buying group to negotiate surgical appliance prices and hence massively reduce the expenditure and cost of delivery of the contract, thereby maximising consultant profit and potentially undercutting the private sector that the surgeons would be competing against for contracts.

    also standardising equipment would lead to faster theatre turn around times and reduce surgery times. this efficiency gain would allow the surgeons to reduce their waiting list and this could then be used to increase their referral base.

    I am being serious. maybe GP's should design tertiary care bowel services.

    I might submit this thread to our local STP.

    -anonymous salaried!

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  • -anonymous salaried! You might submit it - but good (even great ideas) don't make it on their own. You'd have to join the ranks of the committee men and women to execute your plans. Painful.
    And there's the cause of the malaise. Catch-22 revisited. To make a difference, you have to be sane; and nobody who's sane joins those ranks. :-))
    Btw - This theme has a loooong history. Remember Shifting the Balance of Power? Fundholding (nee Budget Holding)?

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  • Salary to be paid as hourly rates then they would not want salaried gp. We work too many hours for little money.
    They must buy premises. We would loose our independence.

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  • Hmmm.
    Despite making him a 'Lord' and then a 'Professor' it seems that this 'Doctor' has not been removed far enough away from the clinical world to cause real harm.

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