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Should the BMA model contract be rewritten?

Only radical changes to the model contract for salaried GPs will make it attractive to partners while preventing a two-tier general practice, warns Dr Clarissa Fabre. But Dr Judith Harvey argues that renegotiating the model contract would just be a way of making exploitation of salaried GPs appear legitimate

Only radical changes to the model contract for salaried GPs will make it attractive to partners while preventing a two-tier general practice, warns Dr Clarissa Fabre. But Dr Judith Harvey argues that renegotiating the model contract would just be a way of making exploitation of salaried GPs appear legitimate



The BMA model contract for salaried GPs needs to be seen in the context of the decline of partner-based general practice. The large majority (70%) of salaried doctors would, if given the choice, prefer to be profit-sharing partners, according to a Pulse survey last year. We are moving rapidly towards a two-tier system in general practice, where salaried doctors are often the (relatively) poor and disgruntled relations of partners.

At present, more and more practices are considering fixed-share partnerships or offering no contract at all to their salaried doctors. Fixed-share partners, although partners in name, have no employment rights and few voting rights. PCTs have little control over what is happening and BMA threats to enforce use of its model contract have had little impact.

The existing contract does nothing to redress these broad structural problems, while creating unnecessary and unfair expenses for practices employing salaried doctors. These conditions will inevitably be detrimental to the quality of general practice. There are four main areas where change is needed:

1. Continuing professional development (CPD)

A full-time salaried doctor, working nine sessions per week, is permitted one session per week of CPD. This is excessive and should be reduced.

2. Profit-sharing partnerships

Incentives should be available, as part of the global sum, for the employment of profit-sharing partners. This need not be new money, but should be negotiated now. The salaried doctors' contract should enable transfer to profit-sharing partnership after a suitable period.

3. Maternity and sick pay

The maternity and sickness benefits in the model contract are, quite rightly, the same as those available to hospital doctors (eight weeks' full pay and 18 weeks' half-pay for maternity leave, and up to six months' full pay and six months' half-pay for sickness). However, while hospital trusts cover the costs for hospital doctors, for GPs the costs are borne by the practice. PCTs make a contribution to locum payments entirely at their discretion and some pay nothing at all.

There should be mandatory maternity and sickness benefits for all UK salaried doctors. This should not be subject to negotiation with individual practices and the arrangements should be cost-neutral for the practice.

This would involve the PCT covering the maternity or sick pay, and also any additional salary costs involved in employing a locum instead of a salaried doctor. PCTs may require extra funding. This is important, especially with regard to maternity pay, to avoid discrimination against the appointment of women doctors.

4. Redundancy pay

Under the model contract, a salaried doctor who has worked in a practice for more than two years is entitled to redundancy pay based on all their years of service for the NHS. This is absurd. The PCT should bear the costs of redundancy for all NHS work undertaken before joining the practice.

Under employment law, an employee gains full employment rights after one year in service. This has resulted in many salaried doctors being given one-year contracts. After an appropriate probationary period (eg six months) there should be financial incentives to give longer-term contracts to salaried doctors.

By addressing these four issues, the BMA contract would become more attractive to GP practices. The need for change is urgent.

Dr Clarissa Fabre is president-elect of the Medical Women's Federation, a GPC member and a GP in Uckfield, East Sussex



Serfs in the middle ages had no choice, no prospects, no holidays, no right of complaint. In the not too distant past, salaried GPs were not much better off. 'Assistantship with view' was the term used in the advertisements. Assistantship meant doing the donkeywork while the partners played golf and the 'view' - of eventual partnership - was down the wrong end of a powerful telescope.

Then, for a few years, conditions favoured salaried GPs. A strong economy and change in the balance between supply and demand meant they at last got a handhold on the levers of power. They got together. They negotiated. They held out for decent conditions of employment and for professional respect. It didn't last.

This is not medieval Britain, nor is it 18th century Russia, but oppression of workers can evolve wherever the labour supply exceeds the work available. We now have an excess of GPs. We have the barons - GP partners - who are under economic pressures and have to realise Government visions. Everyone feels the stress; salaried GPs are the cats that get kicked. Lower pay, poor conditions, less respect.

Employers know they can keep the wheels of their practices turning while offering second-rate conditions: there are enough salaried doctors out there with mortgages to pay. Renegotiating the BMA model contract is a way of legitimising that oppression.

Salaried GPs are not without support. The GPC sessional GP subcommittee, local sessional GP self-directed learning groups and the National Association of Sessional GPs (I declare an interest - I am on the council) all defend the interests of salaried GPs. But the Magna Carta wasn't much help for medieval serfs. When it comes to negotiating contracts many of us are still babes in the wood, prey to bands of increasingly hungry wolves. And the worse the conditions of employment, the more salaried GPs suffer enforced underperformance, which only confirms the barons in their view that salaried GPs are second-class citizens.

The Government is out to weaken the power of GPs by exploiting sectional interests and letting GPs undermine their own bargaining power. Divide and rule is a very effective tactic.

How can we escape from the current situation? History is not encouraging. It took the Black Death to weaken the power of medieval feudalism by making workers scarce. In Russia, history tells us that serfs were officially emancipated on 16 February 1861. But modernising the country was one thing, creating a potentially powerful proletariat required a further extraordinary upheaval.

As in the 19th century, going to Australia may seem a solution for those who have run out of opportunities at home. But we don't need to consider defecting to Australia, or acupuncture, or running a wine bar quite yet. We are all in this together and all GPs are feeling the pressure. In whose interest is it to treat salaried GPs as second-class citizens? It is not in patients' interests, or in the profession's interest, and only in the short run is it in partners' interests.

Salaried GPs aren't unskilled labour. We trained for years to do this job. We are greatly valued by patients. We are a vital part of the GP workforce. We are the flexibility in the system but that does not mean we have to be bent double on a wheel. Being a GP is still one of the best jobs in the world. But salaried GPs must defend their contracts. It honours their value.

Dr Judith Harvey is a council member of the National Association of Sessional GPs and a sessional GP in central London

Should the BMA model contract be rewritten? yes

The contract creates unfair expenses for practices

no

Partners can keep the wheels turning while offering second-rate conditions

Yes No

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