We should nationalise general practice
Dr Dean Eggitt
General practice is in crisis. We need a radical solution to the growing problem. GPs are already preferring to work as locums or in salaried positions to becoming partners, so why don’t we embrace the change and bring all GPs under a national umbrella organisation as employees?
Currently, general practice is a nationwide network of independent contractors to the NHS. These independent businesses carry risks and opportunities for their owners. But GPs are not business people who seek this risk and opportunity. We are expert generalists who are finding it increasingly difficult to manage businesses at the same time as managing complex illnesses.
Solutions that were available to us in the past to manage this risk are no longer an option. PCTs had the flexibility to provide patient care directly where they felt this was necessary. Over the years, though, the availability of this support has diminished and contractors are expected to operate independently within the NHS.
For a number of years, general practice has been struggling to deliver high-quality services amid rising workload, bureaucracy and scrutiny. Recruitment to GP training places is at an all-time low and 30% of our most senior GPs are expected to retire within the next five years. As general practice suffers and recruitment worsens, newly qualified GPs are increasingly reluctant to take on partnerships as this means financial investment in an uncertain future. The reliance on a GP-owned and delivered model of service is now starting to cause problems with succession planning.
The conditions are right to consider ideas that might once have been unthinkable
The inability to replace our ageing workforce is forcing some practices to hand their contracts back to NHS England when they have been unable to find successors to take on their businesses.
The employed and locum models of general practice are becoming increasingly favoured, not only by new doctors, but also by senior doctors who are retiring from partnerships to return to work as locum doctors.
In its current guise then, general practice is unsustainable and GPs are asking for solutions. At the same time, NHS England agrees that the NHS is unsustainable and is in need of a radical redesign if it is to have an affordable future. Thus, the conditions are right to consider ideas that might once have been unthinkable – embracing the employed option that doctors currently favour and gradually nationalising GP practices, bringing them under the umbrella of a state-owned provider with their associated staff as state employees.
Nationalising general practice into a state-owned primary care provider under the care of NHS England or CCGs would not currently be possible without legislative change. One immediately available solution, which would not require a change in legislation, would be to encourage local authorities to take on this role. This would also integrate health and social care at a stroke.
There is currently an opportunity to capitalise on the dire state of the NHS to redesign the service into a model fit for the future and free of profiteering and wastage. As general practices fail and look for solutions, a state-owned primary care could inherit contracts, staff and premises infrastructure. It could reinvest any ‘profit’ made in the delivery of services rather than losing it from the NHS as currently happens.
This would provide an immediate solution to a workforce with no succession plans who simply want to hand their contracts back and work as doctors to help patients.
Dr Dean Eggitt is a GP in Doncaster, medical secretary to the Doncaster LMC and is the South Yorkshire GPC representative