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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

Read more: Should all GPs become salaried employees of the NHS? Yes

Readers' comments (6)

  • Azeem Majeed

    I have listed arguments in favour of the current independent contractor model of general practice and in favour of a salaried service on my blog.

    http://medical-centre.blogspot.co.uk/2013/10/arguments-in-favour-of-independent.html

    http://medical-centre.blogspot.co.uk/2013/10/arguments-in-favour-of-salaried-gp.html

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  • I love the old ICS. It is not anymore. It is Imposed Contracts, reduced pensions and jumping through hoops. Also, a significant fall in income [ -20%] over 10 years, whereas all salaried staff have had an increase. ICS is gone. Either leave, resign or go salaried. ICS will beat you up 8-8, 7 days a week, 24 hour cover. Look at the depression and the people leaving. Salaried has EWTD protection and annual leave. I was an ICS person. Think of the pitfalls of ICS and stay if you wish.

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  • I am moving house and am getting rid of old documents that have been festering in my basement. Found my accounts from 2001 that showed I earned £9560 more then than I did I 2012. How many professionals in the uk could say the same?

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  • GPS remaining independent means that patients are more likely to be treated humanely, rather than GPS being forced towards fulfilling arbitrary budgetary needs...and targets at the expense of patient care. Corporating healthcare is not a good idea.

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  • the best alternative is to go abroad.

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  • As a GP partner single handed you work around the clock with no real clock on or clock off time. The government gets more out of principles this way that you will not from having everyone salaried. Then doctors will come in and do their bit and go home. If you squeeze us too hard then we will leave. Like most of my friends they emigrate for a better life and respect abroad.

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