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We must not be afraid to overhaul the general practice model

We need to take a fresh look at the way general practice is run for a modern health service, says Dr KS Pandher 

I for one welcome the moves to review the GP partnership model.

We need to look afresh at general practice in England. The current model is from the 60s and things have evolved – both medicine and management.

A damaging and wasteful three-tier system has developed.

At the top we have GP partners taking more CCG and other non-patient contact roles.

Then there are the salaried doctors, who I believe are being exploited, often asked to perform the partners’ role – but minus the profit share.

Below them come locums. We need to have an incentive for conversion of this group – they are becoming deskilled in chronic disease management and are tending to rely on new local guidelines for effective management of patients.

Partnerships are also profiting from increased valuation of the premises to which the public had contributed. These GPs should not benefit from taxpayers’ contributions.

In addition, we no longer need GP based dispensing practices in this day and age, with fast online deliveries available. The resources could instead be redirected into patient care.

We need centralised, state of the art premises based in each locality, not the numerous practices we currently have.

I believe the partnership model itself needs to be reviewed – the patients and staff of the practice should all have a vested interest in the practice by being allowed to hold shares in the practice, which should be non-profit making but linked to inflation. This would allow shareholders to have a say in the way the practice should be run to benefit the community. The current use of patient participation groups is not effective, in my opinion,in bringing about meaningful change.

The secondary care NHS model needs to be adopted in part. I suggest GPs are re-labelled as primary care consultants and paid salaries commensurate with hospital consultants’. (Note – to be a consultant you need at least eight years of training.)

Locums could continue to work alongside if they choose that route, but be regarded as staff grade doctors or associates and be remunerated as such. This will bring more GPs into a permanent role providing continuity of care.

Let us look at new ways of working and channel our energy into this rather than being negative all the time.

I do not think public will sympathise with us if we continue to moan without making necessary changes.

Dr KS Pandher is a GP in Oxford


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Readers' comments (11)

  • Is this chap for real??!!

    He suggest all gPs being salaried like hospital doctors - have the waiting lists as you do in hospitals - consultants on contracts resistant to change - huge, huge management costs as there is. No accountability or responsibility. No continuity.

    In my experience salaried doctors and locums do not want to tar the extra responsibility - hence the numerous partnerships available. Locums in our practice don’t want the chronic disease management

    Benefit from premises?? I have had to get a very large mortgage for it, pay the maintenance - he wants new centres ?PFI funded - look where that has got us

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  • David Banner

    Wow, these “partnerships” sound brilliant, massive profits whilst the scumbag salaried do all the work. No wonder doctors are queuing up to become partners, who would want to miss out on unlimited liability, CQC inspections, dwindling seniority and last man standing., the lucky selfish swines. Let’s stop these lazy greedy partners being responsible for any extra work that comes through the door and replace them with hard grafting salaried GPs who declare their surgery full and bounce the rest to the WIC., and cannot work after 4pm to pick up the kids. This will be a triumph for the public who hate seeing the same GP all the time,

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  • Jmd

    The article certainly have started the debate!

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  • AlanAlmond

    What planet is this person on?
    ‘...below them come locums’...really Dr Pandher? So say you. Who on earth are you anyway? How patronising. I really am left gobsmaked by the casual massively overgeneralised condescending tone of this total buffoon piece. How simple everything is in this Drs world hey! LOL. Is this a spoof article?

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  • I am a partner and do believe that nothing is as efficient as the partnership model, it is the only model that can deliver GP consults at about £20 a pop in this day and age. I'm not sure that salaried or locums are that unhappy or trapped, they chose the path. Many locums are in fact partners in their own locum companies (well directors) anyway.
    If the partnership model could be changed to something better it would have been, the John Lewis model has been tried in Primary Care in the past and hasn't proved much in the way of a success.
    The partnership model will change as those with the nous to take risks and responsibility shift their entrepreneurial skills elsewhere. Partners are paid more because they carry a huge personal financial and professional risk, in GP land the end benefit of being able to sell on goodwill and a business has been taken away in exchange for membership of the NHS pension scheme which is slowly being posed for the ponzi that it is.

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  • Brave, thought provoking article. Don't agree with all of it but definitely needs to be more aboutabout locums and notional rent.

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  • If you Google the authors name, you will see similar articles (some of them in pulse since at least 2003).
    I read with interest your leanings towards the 'exploited salaried' by the implied clearly 'more morally corrupt partners'. So it is no suprise that the author is in a salaried post.
    My (admittedly Northern Ireland) views of partnership model are that it needs completely overhauled, but I certainly don't think the exploitation exists here.
    I know we prefer to recruit a partner, but we keep getting told that people applying only want a salaried post or to stay as a locum.
    The salaried docs tend to earn as much if not more, have indemnity and sick leave, maternity leave covered, and aren't exposed to massive bills for premises, staff disputes, ongoing liabilities for staff pay and redundances.
    Author has an arguement, but I don't agree with many of his assertions.

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  • AlanAlmond

    Glued2desk | GP Partner/Principal26 Feb 2018 9:15am
    I area with some of what you are saying but it isn’t true that salaried GPs ‘get indemnity’
    Not all of us do. The place I just left refused to pay indemnity..they simply said they can’t afford it. I left, they’ve replaced me with the cheapest Dr they could get who they get to do all the shittiest sessions and don’t give two hoots for. I know because I worked for these people for more than 2 years and all they cared about was their own individual bottom line. They can do this because they’re in a fairly nice part of town and they run their practice employing disposable salaried GPs and multiple registrars. They are all very nice as individuals but they run their practice exploiting anyone and everyone they employ - including nurses, their reception staff and their poor practice manager, who they don’t even call a practice manager, almost certainly so they can pay her less.. I’m sure there are lots of nice places that don’t or can’t do this but believe me they exist and exploitation of salaried GPs and registrars is very much a real phenomenon not something that can simply be dismissed. The vibe of this article comes out of this, some partners are indeed exploiting their staff...they tell themselves they have to but, as someone who has experienced this very recently, they do it all the same. Maybe they tell themselves it’s ok...for all the reasons you outline. I do not think it’s ok, it’s just an excuse - it’s crap.

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  • AlanAlmond

    ...agree, not area

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  • AlanAlmond

    ...and another thing. Clinically I am as good if not better than many of the guys who claim the title partner. OK so they do the admin and they carry off that burdensome risk, but we are clinicians first and foremost. We are here to treat illness, claiming some kind of overriding superiority and looking down on your colleagues who received exactly the same clinical training, often have more experience and who carry the same risk of being done for manslaughter as any Dr does stick in the throat a little. The government has well and turely screwed us all but that isn’t a reason for a subsection of the work force to feel an entitlement to exploit another

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