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At the heart of general practice since 1960

Young GPs: we need your help to save our profession

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The announcement that NHS England expect to harvest practice-level locum data came as no real surprise. The Government has already revealed how terrified they are of the market rate through the introduction of fee caps for junior doctors which are, quite frankly, insulting, and deserve all of the unintended consequences that they will reap.

If there are no permanent GPs to cover there will be no locum work worth having

The threat is formless on the horizon, but the intended outcome obvious to all: a pliant workforce, managed, rostered, salaried; working cheek-by-jowl in shifts with cheery phys assistants, their Fisher Price stethoscope nestled proudly on their shoulders. They want to smoke you all out and impose limits on your current bounty of choice; yoked and shackled and dependent on the employer.

There really is only one way to resist this, and that’s by shoring the defences. Of my training group (Salford, Class of 2013), only two of 20 or so of us have chosen to saddle ourselves with partnership. My colleagues - excellent, tenacious GPs - have mostly headed into sessional work. That, of course, is the most sensible decision. They are contented and free range, strutting proudly into the sun whilst we toil in the caves of bureaucracy below. They probably laugh at me behind my back, calling me names, decrying my gross stupidity.

But the truth is that it really isn’t that bad. It really isn’t! I still have control over my working life, more in fact, and there is great satisfaction to be gained from helping to shape a practice in your own image, from the responsibility of ownership, from the acquisition of skills I never thought I’d need or have.

I would understand if it really were a world of haves and have-nots out there, of fat-cat partners wolfing cheese and port in their ivory towers and hoisting up the drawbridge behind them. But there are good practices up and down the land desperate for fresh blood and good ideas. Knowledge dissipates into the ether as venerable old pros retire with nobody to take their place. Similarly, there are great GP leaders out there who aren’t giving themselves the opportunity to lead.

The fewer empty seats that are filled - the more practices that go to the wire - the more vulnerable we all are.

The vultures are cocking their heads. If we don’t support the independent contractor model, then we inadvertently serve it trussed up for consumption by the local (un)friendly, aggressively acquisitive super trust. We work for their laughable internal rates. We kiss goodbye to clinical and professional independence and submit ourselves to the whims of adminiodroids, who just needs you to cover that plum twilight shift before they can clock off at 20 to four, goshdarnit. We agree to non-clinical management, infection control autocracy and the kind of unwelcome scrutiny which we all chose general practice to avoid.

We must be very, very careful what we wish for. If there are no permanent GPs to cover there will be no locum work worth having. So I beseech my First5 colleagues: scour the job adverts with an open mind. If there’s a practice you like, take the plunge. Because if enthusiastic young GPs don’t answer the call then we leave ourselves exposed as the bigger picture develops. Like our junior colleagues, we are stronger together. We need your help.

Dr Karim Adab is a GP in Manchester

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Readers' comments (19)

  • Any one with any sense will ditch the country and emigrate Primary car and medicine in this country looks finished.How can anyone commit to a practice when at the moment you might be left with the lease/property/redundancy payments to pay with ever decreasing funding and government not committed to the current model of healthcare.Fundamental change is needed before young proffessionals can commit themselves long term to the UK.I can't see this manifesting in the near to medium term future.Best wishes.

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  • I agree with comment above. Concluding that illegal market fixing means we should cow-tow and become all-at-risk slaves is a bit daft. There are a number of other options
    - Salaried - and walk away when it doesn't suit you
    - Go private - a growing market right now
    - Work abroad - Europe is commutable
    - Emigrate

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  • Dr Adab, I admire your enthusiasm. Give it 10 years of being trampled into the dirt with more and more financial worries and fears, more income being squeezed for so much more output (most of which is utter NHSE dross), your working life dictated to by political whim without any evidence base and I hope your article in 2026 is the same, sadly from experience I very much doubt it.
    Sadly over the last few years every day I wake up with dread looking for a way out of this hell (and I felt like you back in the day). There are much better ways to enjoy things and find reason for your working life.
    Students trust me, 1000's of GPs can't ALL be wrong, can they?

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  • Took me 5 years for the shine to wear off GP.

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  • There has been a straightforward 50% reduction in pay per item in 10 years. If you want that to continue, go ahead.
    If you go bankrupt and need bailed out in spite of seeing 40 patients in a 13 hour day, go right on ahead.
    50% of GPs are willing to leave. That must tell you something.

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  • Vinci Ho

    I cannot disagree that coming and staying in this profession has become a major risk to our lives . And I always say you young guys need to think very carefully before making the choice of staying. It is your own decision and of course , you will have to be responsible to yourself for the decision .
    But we do need people to uphold the flag to fight this crazy war and you have my full admiration and respect to stay on, son.
    There is a Chinese saying ,' I bloody know well a tiger was up that hill but I still insist to walk up there!'
    Salute, Karim

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  • Don't be lulled into contentment by the justifiable comfort of being a "proper partner". In good times it is the best job in Medicine. Been there, done it, innovated the hell out of a dustbin practice (instigated computerisation, paperless, proper admin, clin governance, new premises, trained Nurse Prescribers, set up new dispensaries). When the contract went sour, and secondary care outsourced its a**e wiping to Primary Care it turned into hell. The basic GMS contract is totally laughable and needs to stop. Please don't big it up: the job description is great, but the terms and conditions will kill you slowly. I am now sessional: 99% clinical, 1% personal development. I'll go back in as soon as the fundamentals are fixed, which will never happen. It is over, and that's that. Salaried for a good employer, at the right level of clinical freedom: yes please!!

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  • But there are good practices up and down the land desperate for fresh blood and good ideas.

    But Karim, the system will not let it happen, CCGs have their hands tied or really are run by the really lowest of the low. The Govt want it to fail, secondary care dump everything onto primary care, funding is laughable, income is dropping year on year. I'm sorry but all the good ideas and young blood don't mean jack when you're tied to a tree in front of a firing squad. Shut your eyes and hope it ends quickly. Then again I doubt NHSE could sort that out properly. Steve Field would probably volunteer to pull the trigger though.

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  • I do admire your approach Karim but for me, a GP who qualified in 2014, I am not willing to take the risk of joining a partnership. Locuming is also isolating and pretty bleak at times . In fact, I have decided to work abroad and will hopefully be leaving the shores in the summer. I honestly think general practice has gone past the point of no return for general practitioners in the UK.

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