Should all GPs become salaried employees of the NHS? No
The alternatives are no better than the existing model, argues Dr Michelle Drage
GPs have been starved of investment in staff and infrastructure for the best part of two decades. And yet a million patients are seen every working day by GP practices, with satisfaction levels greater than anywhere else in the NHS and a cost efficiency that is the envy of the world. So the suggestion we give up our independent contractor status raises questions.
Where is the evidence that the alternatives are better than current models, which already include salaried options? Where is the evidence that ideas such as GPs being employed by hospitals would deliver good patient-centred general practice? Haven’t we had enough organisational change already?
Who would be the patient’s advocate when GPs are employed by the provider? What about professional and organisational autonomy? What would be the salary, terms and conditions? Are NHS hospital consultants and junior doctors satisfied with their contracts? Is the NHS a good employer with flexible working?
But the biggest question is this: what is the problem that this debate is supposed to solve? If it is GP overload, try solving it with the same energy and resources that go into system reorganisations, supporting and developing what we have that is good already.
If it is A&E pressure, try investing the resource that has gone into standardising four-hour waits back into primary care. Stop perverse incentives created by payment-by-results tariffs that encourage hospitals to create demand, and instead redirect resources to primary care.
If the Government is worried about being seen to be giving money to GPs, it should put it into community and diagnostic support services. You’ll soon see the added value in terms of patient care – and GP morale.
Dr Michelle Drage is CEO of Londonwide LMCs