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A faulty production line

Opening the door to privatisation

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The classifieds are full of them: advertisements for salaried GPs.

Fifteen years ago, salaried positions were uncommon. Treading the career path from apprentice to GP partner there may have been locum jobs, retainerships or fellowships. And there were some people – mainly women – who worked as GP assistants, part time, without wanting to become partners at all.

But the politics of our jobs have now changed. I am reading through job descriptions where salaried doctors are expected to take on the role of ‘lead’ for QOF work in an otherwise nurse-led practice. Then there are salaried jobs with ‘a view’ to partnership, and PCT-run practices where all the doctors are salaried.

GP partnership profits are now falling, and the push from private companies tendering for primary care services is forcing an inherent instability into the NHS.

The small business model of general practice, which in the past has represented efficiency, community and service, is now seen as rich pickings to profit from – while at the same time the media makes it out to be a greed-driven model that overpaid doctors can make too much from.

This change is on our watch. And every single GP job that becomes salaried makes it easier for the private sector to sneak in and snap it up.

Sharing the load

I understand that it has not always been better to be a partner than salaried; for a long time, salaried GPs may have been paid more for less hassle with paperwork and management. I also understand that, for GPs working in unstable conditions, taking on a short-term salaried doctor rather than replacing a partner like for like might seem more prudent.

But I also know that there are many young, enthusiastic, passionate GPs out there who desperately want partnerships and are not seeing any advertised.

They know that salaried jobs can disappear, or that a management structure can emerge which cares only for points and targets. Partners too should surely know that the more salaried posts there are out there, the easier it becomes for private companies to move in and take over.

Is this really the kind of legacy we want to leave after our turn ‘safekeeping’  the NHS? The good ship is in danger of sinking.

Partnerships can be stressful and the responsibilities onerous. But the best way to reduce this load is not to hand it to private companies  to deal with, but to share it around – with our colleagues as our professional partners.

Dr Margaret McCartney is a GP in Glasgow

Readers' comments (7)

  • So very true, every last word.

    In the words of Private Frazer ' we're all doomed' When the last of the 50 somethings retire in the near future then General Practice is extremely vulnerable to managers employing salaried doctors to work for them.

    QOF will be cherry picked by private companies who offer to do all the diabetic, COPD etc checks. Sold to the public as a good thing because it gives your GP more time to see them when they want.

    My advice. Retire if you can, don't choose medicine as a career and if you are a newly qualified doctor stay in hospital and build up a private practice where at least you are in charge of what you do.

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  • "The small business model of general practice, which in the past has represented efficiency, community and service, is now seen as rich pickings to profit from – while at the same time the media makes it out to be a greed-driven model that overpaid doctors can make too much from"

    So its been ok for GP owners of practices to make rich picking to profit from. But not for other private companies to do so!

    I dont understand why GP's who are so keen on thier independant status fail to see themselves and any different from Virgin Care or United Health in that all are private companies looking to make a profit from the provision of health care services to the NHS.

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  • There is a big difference.

    GP partners often serve their communities for more than 30 years. This is the ultimate in continuity, lasting several generations. They invest in their surgeries and are not in it for a short term profit.

    A practice of salaried GPs is likely to see a high turnover of doctors and less allegiance and investment in the community. It will be impersonal health care and both doctors and patients will lose the fantastic relationships that are so rewarding and supportive to both parties.

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  • I belong to a large partnership - we are currently advertising for 2 more partners. We believe passionately in the partnership model and have always found that works better for our practice. However, when we advertised for a fixed contract salaried GP to tide us over, we had more and better candidates. And frankly with my income having gone down by over 20% in the last year (but no decrease in any of my forced spending on the MDU, GMC, memberships of colleges and the loan on the building I had to take out to become a partner) but my workload increasing constantly with all the new things I am having to do to claw a tiny bit of money back, I am considering joining the salaried brigade. It's not what I wanted to do and not the model I aspired to. But I don't see much of a choice ahead....

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  • There is a crucial, fundamental difference between the GP Partner and the large private corporation such as Care UK or Virgin Health - a GP is a clinician, directly looking after their patients, as well as running a business. GPs make decisions in the best interests of their patients and try to offer the best possible care (in the vast majority of cases), whereas the large private firms are usually run by non-clinicians with no contact with patients-economy and profit is all. A GP partner will usually take a cut in profit to deliver a decent service, the alternative providers would rather walk away from a practice that is not turning an adequate profit in their view. This has happened locally-a private firm won a bid to run 3 practices because they submitted the lowest price; on taking on the contract they went back to the PCT and asked for more money, which they were given. For 3 years they ran practices with a high turnover of locum and salaried GPs before finally giving up and leaving as they could not sustain the model. One of those practices has now closed and over 2000 patients need to find a GP.

    That is the difference.

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  • I know several GP Partner's across a number of practices in this area who are quite open about their aim to make as much money as possible from the profession and then quit.

    Im sure there are practices and large corporations who both work both ways.

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  • another first rate article

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