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At the heart of general practice since 1960

Independent's alright

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We have almost become immune to the constant berating by the press about how GP partners are all lazy, overpaid and clueless. But what we do not expect is for prominent GPs to jump on the bandwagon that GP principals have exceeded their sell by date.

Those who believe that the independent contractor status lies at the root of all the problems in primary care demonstrate at best naivety, and at worst, a hidden agenda. The cracks within general practice are a symptom and not a cause of the crisis that is facing the health service.

UK general practice, through the partnership model, is the most cost-effective delivery of primary care in the Western World because:

We are not paid for activity but through capitation. This means limitless (and often valueless) work can be piled on to us for no increase in income.

  1. We are some of the most skilled GPs in the world, looking after everything from severe mental illness, neonatology, pregnancy and patients with complex co-morbidities who were historically managed in secondary care.
  2. The increased demands and expectations of patients, fuelled by the choice agenda of successive governments, has not cost a penny of public money as it is all being sucked up by partnerships that have had very little investment in the last 10 years.

So why are politicians, the press and now senior GPs questioning the value of the independent contractor status? The answer is very simple.

We are at breaking point.

We have had enough of the bureaucracy, the tick boxes, the protocols, the patients’ demands and most of all, the lack of respect. So in a rather topsy turvy world, instead of addressing some of the issues that are causing this demoralisation, it is felt that the whole partnership model is flawed. Instead of questioning the effectiveness of partnership models, we should be demanding a massive investment into an area of healthcare delivery that has already saved the country millions of pounds.

Those who are happy to abdicate their management responsibilities and  become salaried staff, in return for set hours of work and decent terms and conditions, are deluded if they think things will improve. The country cannot afford us unless we go down a co-payment route and that is likely to be the hidden agenda; blaming GPs for the demise of the NHS.

As for me, I would rather work out the rest of my years, treating everyone equally, irrespective of their income. But I cannot do this without the support of the government and my leaders.

Don’t fix what ain’t broken…just nurture it a little more and you will continue to get the best primary care in the world.

You will not realise this until it’s gone.

Dr Shaba Nabi is a GP trainer in Bristol

Readers' comments (13)

  • Outstanding. Bravo

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  • Outstanding. Bravo

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  • Spot on. Almost exactly what I would write... you know if I had any writing talent.

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  • Hear Hear,but I am afraid those in positions of power and responsibility do no listen.

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  • Sounds great! Exactly what I would expect to hear from the perspective of symbiotic thinking as parasite to begat parasite. The government should not and can not continue to subsidize the public which insults the major constituent of a productive healthy society which are plumbers and physicians

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  • How is the GP practice the "most cost-effective" in the world?
    Very little is offered in terms of "point of care testing " at the GP as every patient is sent to the costly laboratories and the patient patients wait 2 weeks.
    If the government steps back and lets the truly cost effective ( good) doctors provide these services at nominal cost then they would save inlaboratory charges and save a heck of alot of time for the patients.
    "Point of care " providers are the standard of care not feeding the dinosaurs of a government funded sneezing campaign to fuel votes. I guess the structure is set and we never change it with a ballot poll.

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  • '"We are paid by capitation " yes with little to no regard for actual productivity as should be seen in doctor productivity and patient productivity after they are made well and able to live and pay taxes and buy toasters and Vauxhall's and shop at overpriced Marks & Spencer.
    The doctor facilitates this lest the public attempt to survive epidemics such Bubonic plague, Cholera , Influenza, and others and lest we forget the spectacular contribution of Edward Jenner, Sangar, Fleming whom all worked not as "partners".

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  • Una Coales

    I am with you Shaba. Well done!

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  • hear hear Shaba - well said

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  • ' How is the GP practice the "most cost-effective" in the world?
    Very little is offered in terms of "point of care testing " at the GP as every patient is sent to the costly laboratories and the patient patients wait 2 weeks.'
    I get my results back usually the next day or even the same evening if requested urgently. Reliable results without the problems associated with point of care mini labs.

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