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Gerada: GP partnerships likely to be gone within a decade

Exclusive GP partnerships in London are likely to be history within 10 years, former RCGP chair Professor Clare Gerada has told Pulse, as they offer no ‘autonomy’ and are a ‘millstone around our necks’.

In an exclusive interview with Pulse, Professor Gerada – who is now an advisor with NHS England (London) – questioned whether the independent contractor status gives any benefits to GPs, claiming that because of today’s workforce demands on the profession, it’s time to ‘look at alternative models’.

She added that she does not believe that all GPs in London will be salaried in 10 years’ time, but there will be different models of care, and she said the independent contractor model would continue to exist outside London.

Pulse was speaking to Professor Gerada following the publication last month of NHS England (London)’s ‘transformation framework’ – led by Professor Gerada – which outlined plans for practices to merge or federate to offer routine opening on Saturdays and offer flexible appointment lengths as part an £810m a year bid to reshape general practice in the capital.

Her comments come as NHS Hull CCG revealed last month that it is in talks with GPs about a projected move to a completely salary-based model of primary care, in a bid to tackle major recruitment problems in the area.  

Professor Gerada’s thoughts also echo comments made by shadow health secretary Andy Burnham, who previously told Pulse that the profession ‘should move towards becoming predominantly salaried,’ while NHS England deputy medical director Dr Mike Bewick said earlier in the year that GP partnerships will be ‘gone within ten years.’     

At the RCGP conference last year, while still college chair, Professor Gerada called for GPs to give up their independent status and become salaried employees, saying that the independent contractor model was ‘anachronistic’.

But, speaking to Pulse this month, she went further, arguing that the GP partnership model would be an anachronism in the capital within a decade.

Professor Gerada told Pulse: ‘I don’t think everyone will be salaried. I think there will be different models. I think we’ve already seen it in London. If you say will there be independent contractors in London in 10 years’ time, I suspect not.

‘But if you ask whether independent contractor status will remain in some areas of Britain – yes of course it will. I would question whether the independent contractor status is beneficial to GPs. With today’s workforce, today’s demands on general practice, with the media seeing us as fat cats going off to play golf every afternoon because we are independent, I think this is a millstone around our necks and the sooner we look at alternative models the better.’ 

Professor Gerada foresees GPs being independent contractors to primary care organisations, adding that ‘new models will emerge’.

She said: ‘But the partnership model has stood the test of time for 70 years and it will probably stay around in certain areas. We could even be independent contractors to a primary care organisation. I think models will emerge. I’m not saying one size fits all.’

She went on to add that these new models could include completely salaried structures.

‘Shareholder models are already emerging. Social enterprise models, or completely salaried models, even models of foundation trusts employing GPs. You need to work out want you want to deliver, make the system safe, not for profit, then GPs with the right resource will make anything work,’ she said.

 

Readers' comments (53)

  • Yes absolutely right.
    Contracted almost entirely to the NHS.
    Ceiling on maximum earnings.
    What self employed person puts up with that?
    Bring on the salaried service!
    Give me the equivalent remuneration of a partner, but I won't promise I won't become a jobs worth!

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  • Loss of IC status - loss of what made GP great in the first place.

    24/7 shifts, pitiful pay, constant managerial interference about hitting targets, loss of continuity. Even worse disenfranchisement and poorer job satisfaction.

    Deja Vu?

    that was your 6 month rotation in casualty as a GP trainee.

    RIP General Practice.

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  • I agree that currently partnerships are "a milestone around our necks".

    However if we want to retain GPs then our pay in an alternative model needs to pay well or otherwise we will continue to have lower number of doctors training to become GPs and continue to haemorrhage doctors from retention/early retirement.

    In the next few years we will reach a point where we will have a critical numbers of GPs before the system implodes and secondary care at that point will not be able to manage the flood of patients that have been managed by us.

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  • Why does Claire keep promoting this model (aside from the obvious)?
    How do you get people to sign up to terms which are likely to deteriorate over time and they have little control over (see consultant contract negotiations)?
    What would happen to the premises?
    How do you develop services flexibly enough to fill changing community needs?
    How do you implement EWD in primary care?
    Where are you getting the extra doctors for this model (practitioner models won't ever fill the gap)?
    Who will manage the surgeries and how much will those extra managers cost? Where will you house them?
    What about indemnity since partners are such a big risk sink?
    What happens to pensions and national insurance?

    The OECD reckon the NHS to be about as efficient a model of care as can be delivered. Why break it up just to pay off some lobbyists in Whitehall?

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  • Salaried model £80,000 for 10 session week max and it will be squeezed by employers,ICS with all tax perks notional rent scheme and abandon defunct NHS pension scheme is worth £120-140,000 minimum for 8 session week and you are your own boss
    Sorry your grip on personal finance Clare is hopeless or you have another agenda
    If a salaried scheme pays over £100,000 it has a chance if not will surgeries will be staffed by locums operating out of chambers
    The willingness of our colleagues to work as independent locums has always been the weak link in the salaried option as market forces drive up pay,we owe them a debt of gratitude

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  • If there is a wholesale move to a salaried model......
    - doctors will move around to better themselves and continuity will be destroyed.
    - a shift system will have the same effect.
    - it will be enormously more expensive.
    - doctors will chose to work as locums either independently, for an agency or a chambers.
    - partners currently sacrifice themselves and their families for their practices. This will stop and a significant number of doctors will do what they are contracted to do and no more.
    - the European WTD will apply and more doctors will be required.
    - general practice will be even less attractive than now and fewer people will want to do it.

    Madness!

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  • The partner ship model is why your NHS survives, without it you will be like the USA.

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  • Why is Clare Gerada's conflict of interest never mind. She runs numerous surgeries with locums and salaried and it is in her interest that we become all salaried.

    This somehow is never mentioned!!!

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  • Anonymous | GP Partner | 11 December 2014 6:45pm

    ".....surgeries will be staffed by locums operating out of chambers"

    You are absolutely correct ...in fact this is what is happening already. I can think of several practices in my area who are basically filling their rotas with independent freelance Locum GPs because they can not employ anyone on a contract. People aren't taking up partnerships because the model has been squeezed to death by the government. Increasingly people aren't taking salaried jobs either and opting to work as Locums because they have far more control and the pay and conditions are preferable.

    If the partnership model is consigned to history the work force will increasingly become one of independent Locums who hire out their time to non partner practices. We will go from one independent practitioner model to another. For the tax payer the deal will be worse because you will have to pay Locums the market rate..and that will be expensive. Locums will not have the personal investment in an individual practice either..again to the detriment of the customer (i.e. Patients) and this again will increase costs.

    Destroying partnerships is basically an invitation for General Practitioners to leave the NHS and set themselves up as completely independent service providers working out of chambers. It won't be a salaried model...it will be a freelance Locum model.

    From a purely personal perspective I'm delighted. I have been working as a Locum GP for the last 2 and a half years and I think I have my work life balance pretty much sorted. I am mid career and unless someone offers me an unusually attractive salaried position this this the way I plan to continue.

    However from the perspective of the tax payer and patients (we are all patients ourselves too) it will be a bad development indeed. Practices staffed by temporary employees with no allegiance to the practices they work in being paid at market rates. This sounds like an expensive service with little continuity. It's is continuity of care that again and again people rate as one of the most important things they want from their GP - this will be gone. 24/7 staffing will cost a fortune...too expensive I bet to have GPs doing the work.

    If they just funded partnerships adequately and invested as they should a great service could be maintained but short-termism is the nature of politics and it seems this is the way it's going to be.

    If the government try to make being a Locum unattractive..there just won't be any Drs left working as GPs...it just won't make sense to spend that much money on a medical degree to become one....unless they make being salaried worth while (expensive and less efficient that partnerships)

    Partnerships are good value for money but are set to be abandoned. We are basically throwing in the towel on NHS general practice by going down this route - in fact I'd argue it's actually throwing in the towel on the NHS full stop. I find it more than a little depressing that a former chair of the RCGP is pushing for this very thing.

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  • Clare is right because partners are retiring / resigning in ever greater numbers, and young GPs entering the profession are no longer interested in partnership responsibilities.

    Simon Stevens 5 Year Forward View considers two integrated care models - one community driven, the other hospital run - which will both essentially depend on salaried medical practitioners.

    But as pointed out elsewhere, it won't be cheap. The UK offer is currently unattractive in international terms. Expect salaried / locum fees to rocket as the manpower shortage bites . . . .

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