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GPs buried under trusts' workload dump

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)

  • Or you could increase payments direct to GP partnerships by 30%. And simultaneously scale back CQC and appraisal. As the frightened GP's blink in the daylight after escaping back to back 12 hour days, a new dawn approaches. Partnerships start to become in demand, and GP surgeries multiply. Locum doctors start to come back to regular employment, and patients ask the receptionist to "come again" when the can see the same GP 2 weeks later about their complex multi morbidity and polypharmacy. Practices have frequent meetings with time to anticipate their vulnerable patients needs and take appropriate proactive measures. Pharmacy bills drop as detailed medical reviews with patients allow only necessary medications to be continued. ED attendances fall as patients have confidence of being seen urgently by their GP. Peace extends across the land.....

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  • Only 4% of GP trainees want to be partners - I don't think this will change which means partnerships as we know it will (unfortunately) have a slow and painful death with increasing stress for the dwindling number of partners left. Life is lived forwards, but must be understood backwards..

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  • I am disappointed not one of our GP’’s have questioned who commissions Lord Darsey not when he introduced D’arsey centres and not now....and what is the real motive behind this pawn.
    BTW ....I was there practising when there was massive vitriol which histrory has proved right when he first tried to dismantle Primary care.

    Our divided opinion is their unity....you buffoons....wake up and smell the coffee.....Argh....

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  • You’re a surgeon. Utterly pointless with regards to GP, and a huge insult to everyone if someone thinks you are best suited to redesign primary care with no knowledge of it. A joke!

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  • I saw this joker on TV yesterday. He lacks insight.

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  • Salaried would be my preference every day of every week of every year, Anyone here saying that it wouldn't work hard because they wouldn't commit to working hard because they are not a partner is wrong. I have been in salaried roles and in partnership, my commitment to doing the right thing doesn't alter. What does change is the knowledge that I will get paid a fair wage for a fair days work, I will get the opportunity to work in a role that is defined and allows me to focus on what is important and I am not going to come home to worry about the staff, the lease, the contractual obligations.. etc....
    Young GP's don't want to be partners, they recognise that buying in to the opportunity to be legally bound to a contract that opens you and your family to financial ruin in return for the opportunity to merely earn the same wage as a salaried GP who doesn't have the same risk is a nonsense. Hang on to your partnerships and bury your heads in the sand if you like but when you pull your heads out and look around, don't be surprised to find you are the last partner standing on a contract that makes you liable for providing the service, employing the staff and servicing the loans and the lease with no one vaguely willing to take your place. why???
    The GPC have negotiated us into this position, it is right to say that this is a resourcing issue and that if partnership and the GMS contract were resourced better we would be in a different position but that is not where we are. They have incrimentaly negotiated a contract that is undeliverable as the workload is unsustainable. There would be no way that a similar expectation could be placed on a salaried worker, it would be illegal. There is also no escaping that there is no way that the NHS is going to invest in a contractual model that is impossible to manage and has proven an barrier to integration and modernisation. The only way to secure investment in Primary Care in the future is to accept radical change, become salaried consultant generalists, leading teams in the community that deliver complex integrated care to our populations.
    Look at the opportunities, don't cling on to the wreckage!

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