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Independents' Day

The Scottish contract doesn’t work for millennial GPs

Dr Punam Krishan

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This year we in Scotland welcomed a new GP contract. At the time of negotiations, I was a partner and – from my perspective – the new contract seemed fair. Abolishing QOF and introducing collaborative multidisciplinary working across practices within designated postcode boundaries seemed like a step forward.

A designated GP practice quality lead would meet with their ‘cluster’ of practices on a monthly basis to discuss barriers to quality care delivery in the hope of unifying health messages across the board. The cost for premises would soon be abolished and, for the first time, GPs would be given the recognition of being expert medical generalists.

All these changes were made to empower existing GPs, by helping to lessen the burdensome workload and by enticing new doctors to become GP partners.

Fast forward a few months, I’m now a sessional GP and I view the contract differently. I am, of course, an expert medical generalist and I want to know what’s happening with the new contract developments that influence the care that I deliver to my patients. I want to know what system changes are happening because, for example, although QOF was onerous, it was familiar. However, there are now whispers at the top that are not reaching everyone on the ground.

I'm now viewed as a petulant truant who will soon return to partnership

I recently asked an important person why the new contract didn’t feature the role of the sessional GP. I was amused at the response: ‘You’ll find out when you decide to become a partner.’

Well, you see, I was a partner and I recently resigned because, for me, the pressure and pace of both managing and running the practice was too much. I needed to regain control. I wanted to find balance again, to enjoy the work. To have time to pursue specialist interests that had been suppressed for too long due to mounting pressures of never ending practice related work.

For these reasons I do not want to return to running a business anytime soon, but that doesn’t make me any less of an expert medical generalist. Yet, even though I have more experience than a number of my partner peers, I’m now viewed as a petulant truant who will soon return to partnership.

Portfolio sessional working has become a way of life in the modern age. As well as being young GPs, we want to travel having spent years studying in the one place. We want to explore our options because we are raised on options. It is common to rent a home before buying one. Same goes for dating before settling down. Why then would we want to qualify and become partners in a practice, fixed in one base, for the rest of our life?

Premises or no premises cost, leadership entitlements or additional allied professional support, none of this holds appeal to the millennial doctors to whom I speak. Who would want to take on partnerships where the daily business tasks detract from the reason we went into healthcare in the first place?

The reality is that partnerships are a lot more complex and politically charged than the new contract addresses. Partnership, frankly, was a stress best avoided in my own case. Let’s not forget the financial implications of partnership which can be a nightmare to break free from. The contract offers no help on this.

Sessional GPs have varying roles, some permanently based within a practice, some permanently working between practices within a designated cluster and others providing services wider still. These GPs have far more knowledge and experience of systems that work and systems that really ought to be shut down.

The contract is disappointing because it fails to acknowledge one of the fastest growing career choice – the portfolio sessional GP. These are GPs with medical generalist expertise gained travelling to various practices providing support, cover and care across the country. To not feature their contributions, to not give them a seat at cluster level negotiations and to not acknowledge them as an equal expert is a stark flaw in the new Scottish contract and must be rectified.

Dr Punam Krishan is a sessional GP in Glasgow


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Readers' comments (16)

  • This has always been the case and is not new for the Scottish contract. Salaried GP’s have always been disenfranchised - to the detriment of the profession.
    Which is one of the reasons I am a locum.

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  • There is a lot of difference in being a GP with their own designated list (usually a partner) and sessional, mobile, or part time GPS whether salaried or locum and not having their own list. The recent research showed patients not only prefer a full time vocational GP but they, the patients actually live longer. The health care landscape is becoming so fragmented and confusing patients need one clinician they can depend on.
    The partnership model still allows us to control our work and we lose it at huge cost.

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  • GP has long been said to be a business. Funny thing is I don't know of any other business where one party can unilaterally, frequently and contentiously make alterations to the contract. It seems crazy to some?

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  • I am struggling to understand what specifically is in the Scottish contract which makes it challenging for sessional GPs.

    How much leadership a salaried GP depends on the appetite of the salaried GP and the ethos of the partnership.

    A GMS contract is negotiated between partnerships and the government. A salaried or locum contract is negotiated between the partnership and the individual GP. (with BMA model contract in mind)

    Or am I completely missing the point?

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  • Having been a GP Partner myself and now sessional, with less than 4% of younger GPs wanting to be partners the model is not going to survive.

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  • Can someone define for me the thrice-repeated mantra "expert medical generalist"?

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  • Seems that millennial doctors are no better than millenial everything else’s. Snowflakes that want everything laid out for them on a plate but don’t want to do any of the graft to get ahead and support other people. Too precious to run a business yet they want leadership roles in a community they don’t and likely won’t ever commit too. The end of the NHS is nigh. God help us all!

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  • David Banner

    Millennials can’t be blamed for snubbing partnerships. Back in the 90s we all competed to obtain them, a job for life with financial security, where do I sign? But the oft repeated woes of 21st century partnerships (unlimited liability, falling profits, workload dump, CQC, last man standing et al) have conspired to torpedo the model. Would anyone trapped in their partnership become a partner if they had their time again? Of course not, so don’t blame the millennials for having the sense to avoid partnerships like the plague.

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  • I like to think my millennial offspring would likewise turn up their little instagrammable noses at a job that makes infinite and increasing demands, offers limited and diminishing rewards, and revolves around the collection of an ever-changing battery of meaningless metrics. The problem isn't the work ethic of a generation, it's that general practice partnership has become an Orwellian dystopia.

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  • I can see both sides of the argument but taking it from another angle what is best for patient care and most efficient for the NHS? A GP partner working 6+ sessions a week and knowing his/her patients offers more continuity and fewer investigations, referrals and possibly admissions than a 4 session portfolio GP. If Scotland wanted to encourage partnership I don't blame them if (big if) they are using this measure.

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