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General practice should move towards becoming predominantly salaried, says Burnham

Exclusive General practice should become a predominantly salaried profession, with GPs working as employees of large health and social care organisations, shadow health secretary Andy Burnham has told Pulse.

In an exclusive interview, Mr Burnham said the salaried model would be more financially sustainable, helping to ‘unlock’ funding ‘tied up in hospital’ and also help GPs cope better with patient demands.

Having previously indicated that GPs’ independent contractor status could be reviewed under Labour, these comments are the strongest indication that the party wants to move to a model of integrated care organisations that employ GPs, rather than GP partnerships.

Under the plans, which Mr Burnham said mirrored visions presented by the Royal College of Physicians’ Future Hospital Commission, GPs would ‘not be loyal to primary care or to the hospital but to the local population’.

Mr Burnham said: ‘I think that is the way we need to start thinking and be open to the idea that that might mean a GP working as a salaried employee of an integrated care organisation.’

Initially when asked whether his vision meant GPs would no longer be independent contractors, Mr Burnham said: ‘Not necessarily. I mean they could be.’

However, he later added: ‘I do actually see a role for more salaried GPs… outside of those contractual models. I think younger people might be more attracted to salaried employment.

‘I can very much envisage a future where we have more integrated care organisations that employ GPs, and the GPs will sit at the centre of teams that are multidisciplinary. They may be the decision maker if you like, or the kind of ultimately accountable person operating this different model of care.’

Mr Burnham also said that working within these organisations is how Labour envisages that GPs will be able to fulful its promises for patients to be able to access a GP appointment within 48 hours.

He said: ‘What I am saying is it is not just the GP sitting there and working through it. It is about the GP saying: “look if you need bereavement counselling I am going to get it for you today, because we have a structured person, provider, organisation that does this”. Or if it is relationship advice, benefits advice, IAPT or whatever it might be.

‘[Within the model] those non-medical interventions can be drawn down as quickly as it can be to give people a bit of paper to get some medication. I think that is about empowering the profession to really deal with people’s problems and help them regain control of their lives rather than just managing the symptoms of people’s lives.’

Mr Burnham also said he thinks this would help attract new recruits to general practice by ‘painting a picture’ to graduates of a profession where ‘people’s horizons are not quite as limited’ and where you don’t have to ‘take on commitments at a local level, the practice, almost commit your career to one area’.

However, deputy GPC chair Dr Richard Vautrey criticised the plans.

He said: ‘I think if his plan is to actually increase the number of salaried GPs that means large numbers will look at general practice and say it is not for them. They want all that comes with being an independent contractor. Many would aspire to be independent contractors even if they initially wanted to become salaried GPs.

‘I don’t think that the idea that just having lots of salaried GPs will solve the problem. If we want to encourage doctors to choose general practice then we have to maintain and offer the range of models for doctors to work with.’

Former chair of the RCGP Professor Clare Gerada caused controversy last year with her suggestion that GPs should relinquish their independent contractor status. GPs reacted overwhelmingly against the suggestion and a Pulse survey showed more than three-quarters to be against such a move.

More recently, NHS England’s deputy medical director Dr Mike Bewick claimed that GPs’ independent contractor status will be ‘probably be gone’ within ten years.

Related images

  • Andy Burnham MP 2014


Readers' comments (81)

  • Jealousy of GP partners status and pay driven the Persecution and of Partners under all Political umbre4lla for the last 10yrs.

    Any vote for a politician - same Sh@t different day.

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  • Enforcing employed status allows better control of costs, driving down incomes/salaries as non-acceptance would result in not renewing contracts!
    I won't be in the UK hopefully this time next year! My income dropped significantly as a partner, to the point it is hardly worth my while continuing. Better options to give me and my family the life we deserve after years of hard work and academic and commercial achievement!

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  • Dream on with the model...no party can deliver the level of funding required to provide such services on the NHS, same day, for the demand of the consumeristic patient.

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  • Vinci Ho

    You have been suggesting that all this time anyway , Andy. But you have to be very 'careful' how you are to word this to people.
    The ratio of partner to salaried GP is what will be an interesting debate in next government .
    Again advantages against disadvantages. Large , corporate organisation against small to medium sized business. The 'nature and true face' of these larger integrated organisations can be contentious .
    100% salaried GPs in primary care is not the perfect Holy Grail......
    Anyway, good luck to all Evertonians for tomorrow night Europa League.( Of course, to the Scots tomorrow as well)

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  • Yeah, Good luck to the Scots and maybe the NHS reforms will frighten away the Irish and Welsh next. Westminster has only itself to blame for the party.

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  • Seriously why do we put up with this rubbish?

    It's fairly obvious that pay and conditions would be far worse under a salaried model and patients would not get the same commitment. Costs would also rise as independent GPs do so much unpaid work and I seriously doubt we have enough GPs if we are restricted to EWTD hours.

    There is only one logical solution and that is to remove political meddling from primary care by moving to a fully privatized insurance model charging market rates as is done in the rest of Europe. The alternative is death by a thousand cuts and ever more politicos making money off our backs whilst further damaging patient care.

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  • So all the primary care problems will be solved by being salaried not partners? Who would have thought that the answer was so easy? Aren't we all fools for not seeing it, right in front of our noses?

    Or maybe it is Mr Burnham who is the fool. Do you really think that whether a GP is a partner or salaried makes the difference Mr Burnham? Well let me confirm that you are right! A partner does quite a lot more work than salaried in my experience, so your great plan, Mr Burnham, will see less work done by the same number of doctors. Genius!!

    Of course the real reason behind this puerile scheme is not to improve patient care but to find a scapegoat for the NHS's deep problems caused by politicians, and GP Partners.

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  • Bob Hodges

    Salaried GPs might actually take leave when they're ill, and go home when they their 'shift' finishes'.

    Be careful what you wish for.

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  • i actually dont have a problem with this in principal
    -large scale organisations would have to cover my indemnity, sick leave etc. I have always thought independent contractor status was overrated.
    HOWEVER - somebody better tell me what will happen to the mortgage on a surgery that has 22 years to run and is in significat negative equity. Will I be left with this albatross?????????

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  • Harry Longman

    Mr Burnham, so well meaning, such dangerous ideas. When all of Europe wants to be more like the NHS, you are digging up the foundations. Continuity is the bedrock of general practice, which is the bedrock of the NHS, the world's best healthcare system. Your plan will destroy it.

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