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Special report: Continuity of care threatened by rise in salaried GP posts

By Christian Duffin

General practice is losing its ability to offer continuity of care as it becomes an increasingly salaried and part-time profession, a Pulse investigation reveals.

Our detailed survey of 500 GPs provides the first evidence that the trend to replace partner-ships with salaried posts is having a profound effect on the kind of service the profession can deliver.

GPs overwhelmingly value continuity of care, with 98% of partners and 90% of salaried GPs saying it remains key to general practice. But while three-quarters of partners still feel they can offer their patients continuity, among salaried doctors that figure is far lower, at only 48%.

More than half of salaried GPs work part-time, whereas just a sixth of partners do. As a result, salaried doctors know far fewer of their patients – seeing an average of just 26% of their patients regularly, compared with 42% for partners.

Latest figures show the number of salaried GPs more than doubled between 2004 and 2007, from 2,742 to 6,022, and any indication these GPs are unable to deliver a key element of patient care is likely to send alarm bells ringing among GP leaders.

The GPC set up a working group in April to look at ways of encouraging practices to make more partnerships available. It will also look at concerns raised in a previous Pulse survey that salaried GPs are not always offered appropriate terms and conditions.

Dr David Barrett, a GP in Coventry who used to be salaried but is now a partner, said partners were in their posts for longer periods and had greater opportunities and more incentive to offer continuity of care.

‘The difference is down to the investment in the clinical side of things. Salaried GPs are usually part-time. You are working reduced hours without the remuneration. There is no feeling that [continuity of care] is worth the investment.'

Dr Ruth Chapman, a salaried GP in Sheen, south-west London, said salaried GPs were often being taken on with short-term contracts.

‘I have been salaried for seven years, and there are patients I have seen regularly over that time. That works fine for me, but it would be good if some other practices went to situations where they employ more partners instead of short-term salaried GPs.'

She cautioned that continuity of care could be hit further if private sector involvement further increased the number of short-term contracts on offer.

GPC negotiator Dr Peter Holden said there was a culture change in society – including general practice – which meant people tended to stay in their jobs for shorter periods than previously and this would inevitably mean fewer patients receiving continuity of care.

Sign of the times: salaried post expansion losing continuity of care Sign of the times: salaried post expansion losing continuity of care

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