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At the heart of general practice since 1960

We should nationalise general practice

Dr Dean Eggitt

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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

This blog is part of our ‘Great GP Debate’ season. If you would like to write a blog on how you see the future of general practice, then please email the Editor at editor@pulsetoday.co.uk.

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Readers' comments (14)

  • Partnership are not being taken up because primary care is underfunded.The risks, debt,redundancy,litigation etc are not compensated for by the renumeration in the UK.We RELP because that way we mitigate risk, we work when and where we choose and we maximise are income for the risk taken.Becoming a salaried minion will not do this(look at the rest of the NHS)this will hasten the death of primary care.Time for plan B, give us a vote explore other options rather than the all you can eat buffet abused by everyone that the NHS has become.

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  • Yuks what a horrible suggestion.
    You would pay twice as much for the same outcomes, unless you follow the practice of other communist organisations and bring in forced labour.
    How many millions died under communist regimes who nationalised another time sensitive complex system - food production?

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  • By the very fact that OOH would be built into the system would remove this one worry, but essential to all of this would be a willing workforce. Unless the contract was desirable the only doctors willing to take it on would be those in the middle of their careers. Those at the end would leave, those at the beginning would retrain. As I've said before it would end continuity of care.

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  • It would be a total unmitigated disaster. The NHS has already proven itself more than willing to abuse it's staff to satisfy the whims of senior management. Independence saves us from what the junior doctors and now consultants have to endure. The starting salary for consultants is now around £76k. They have been demolished in terms of both status and pay. The trusts are in huge debt and the councils cannot afford to pay for social care. What do you think would happen to us if they took over? Hospitals are much less efficient than we are. It would be the end. There is only one answer - do what the rest of the planet does and accept co-payments. We can only save general practice if the resources are there.

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  • I think that the penny as dropped at DOH about the sheer value for money that the partnership model brings. OOH is a good example. It would cost vast amounts, as docs go off sick and refuse to see extras etc. Rotas would be impossible to fill. It may be good for the health of docs in the early days but for the country and medical profession in the long term I am not so sure.

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  • Government is in a dilemma over this. They would dearly like to end partnerships and break up what they see as an awkward, inflexible, independent power block of obstinate GPs. However, they also realise (after the OOH debacle) that they couldn't run primary care more efficiently as a salaried model. The plan has therefore been to squeeze partners until the pips squeak to see just where the breaking point is.
    If HMG seriously wanted to run a salaried service they would be buying out failing practices, rather than letting them go to the wall leaving partners with huge debts. The government may hate us, but they realise that they need us.

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  •  Dr Kon Conrad

    I agree with Dr Eggit's proposal. Our current primary care model worked when I became a principal in 1984 but is increasingly difficult to manage and the GP workforce now is very different. Partners deserve as good a work life balance as salarieds and locums. Let's join them.

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  • I couldn't agree more. General Practice as the small "corner shop" is an anachronism now and whilst it had evolved as an independent small business, none of the younger GPSTs I see have any appetite nor the training to develop their business expertise and would rather devote their time to delivering high quality patient care with a multidisciplinary team and a clearly defined contracted role equivalent to our Consultant colleagues in secondary care. Not much to ask surely ......

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  • A salaried service is fine but ask any of your consultant colleagues they are abused and overworked and exploited and can't wait to get out either.With the current model of healthcare the medical profession is grossly disrespected in the UK compared to our international brethren.The Whole of the NHS needs to come crashing down and we need to have a model of care which has an element of demand control, unlike to free buffet we have now.The whole NHS is the problem we shouldn't prop it up when its the reason for this mess.

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  • GPs have a choice to be salaried now so why try to impose your choice on others by forcing all GPs to be salaried state employees?
    And would you rather be a salaried employer of a partnership or the state? The examples of PCT controlled practices show the latter requires considerable danger money to attract employees.

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