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GPs to move ‘as close to salaried as possible’ under radical plan to reduce workload in Scotland

Exclusive GPs will give up employing practice staff and potentially have contractual limits set on their workload under proposals being looked at by Scottish ministers.

The proposals will see GPs share responsibility for care with a wider ‘primary care team’, in a move that will see the profession move ‘as far towards salaried model as possible without losing independent status’ by 2017.

Under the plans – currently being developed by Scottish GPC and discussed with ministers – GPs will be contracted as independent ‘expert generalist medical advisors’, potentially with limits placed on their workload and their gatekeeper role shared among other professionals.

GPs will only be responsible for the direct care they provide under the plans and would no longer employ practice staff, with practice pharmacists and nursing teams directly employed by health and social care boards to carry out health checks, QOF work and prescribing.

The plans will be officially presented to GP leaders at the LMCs Conference in London later this week and they have already received backing from the Scottish health minister Shona Robison.

She told delegates at Pulse Live in Edinburgh today the ideas were ‘compelling’.

GPs in Scotland have a three-year pause in contract changes until 2017 in order to agree a completely new GP contract

Speaking at Pulse Live, Scottish GPC chair Dr Alan McDevitt said the current independent contractor status model was too risky and putting off potential new GPs. He said the new proposals could ‘engender hope’ and ‘encourage more GPs into the profession’.

Dr McDevitt explained: ‘We are arguing for a physican-led primary healthcare team – it doesn’t mean you’re the boss because you don’t employ the team but you should be leading how to achieve the outcomes, providing expert medical support to those team members.’

He said the contract with the local health organisation would ‘still be based on practices and practice lists’ as this allowed ‘the personal, relationship-based care fundamental to the future – that’s how we manage risks in the community, that’s how we have joint, shared decision making with patients’.

But he said this would mean ‘the community gets a share of the GPs’ time’ and that GPs will only have responsibility for the care they directly provide.

He warned that if negotiators failed to secure a more attractive independent contract for GPs they would end up with a fully salaried model, but that the aim was to ‘try to keep the best of the independent contractor status at the same time as getting rid of the worst of it’.

Ms Robison said the new GP contract from 2017 was a ‘big opportunity’ to change general practice.

She said: ‘We have had this discussion… about moving away from the kind of gatekeeper role of general practice to a model of primary care being a wider health team, with GPs being the clinical experts.

‘That’s something that I know the BMA and the RCGP have said is a more sustainable model.’

She added: ‘But the GP would provides the clinical expert advice to that primary care team - that is quite a different model to what we have at the moment - but the RCGP and the BMA are saying this is a good model to work towards.’

 

 

 

 

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Readers' comments (37)

  • Confirmation that the government,BMA +RCGP are all in cahoots to bring about the end of GP as we know it and usher in salaried minion status.The devil is in the detail and these plotters need to remember that new GPs will have circa £100000 af debt to pay off after medical school so they will not be happy with "Macdonalds" medicine with a poor income.

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  • So more like medical teams in hospital.

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  • "We will reduce your workload by having you spend more time in meetings". Sounds like a plan.

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  • This is hilarious. Break up the most efficient bit of the NHS, the independent GP contractor. Watch the costs go up by ££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££

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  • Once Pandora's Box is opened, watch the pain and chaos spread, as will disease and pestilence.

    Once GPs are forced into salaried roles, Private healthcare will sweep up the easy pickings turning us into the same mess the US healthcare system is in, with the haves, and have nots.

    Strange the whole world wants to be as efficient as the NHS primary care system, and Scotland leads the DOH moves towards private healthcare for their Private Healthcare masters.

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  • "But I don't get on with my allotted practice nurse / secretary. Apparently it's no longer there job to do what my previous team did... You mean I can't prefer this patient without going through the referral committee."...etc..

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  • you need to realize that the survival of the NHS is more important than general practice or GPs. without it the BMA and RCGP would cease to exist.

    we had our opportunity to discuss other models and go the way of dentists but nobody wanted to talk about it - it was beneath them. now it's too late - expect this to move to England as well.

    my advice to any young Dr - retrain to be a plumber you will have more professional autonomy and respect.

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  • Without GPs the RCGP would cease to exist,and the BMA would be short of a lot of money and numbers to give them muscle.Why no consultation with the proffession(grass roots)to see what we feel is needed.Oh forgot the great and the good know whats good for us poor surfs!

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  • Interesting if England doesn't follow too quickly, the mess may just persuade NHSE to realise what it's got!. Once this plan goes inand costs increase and the unfunded work become undone work as well the patient will end up inapprpriately managed and those with the greatest need will not have access to GPs as they'll have picked their quota!
    Reminds me of the old joke about the sergeant in the war sitting under a tree smoking a cigarette when his captain says 'were outnumbered 4 to 1 what are you doing?' The sergeant replies' well sir, I've shot my four!'

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  • In such a system there is a good opportunity to establish private practice as the service patients will recieve from the state funded system will inevitably decline due to funding and staffing issues.

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  • Can't wait to see what is going to happen in Wales. There is a year and more waiting list for a dentist.not a named practice but to get on a general list held by the health board to finally get allocated to whichever one reports a vacancy. Even private practice lists are closed now. RCGP should be ashamed of itself for keeping quiet about what is going on - some of them have been hinting via the media when they had an obligation to come clean about this proposal which must have been months in the making -ages ago.

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  • Probably worth pointing out that our Scottish colleagues on the workshop floor , have to agree to this. Otherwise won`t work.

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  • This makes me want to reach for the sick bowl.
    These ministers seem to be seeding with GPC Committee members - likely many of whom are in big salaried surgeries anyway. Large practices do not offer the best quality of care and small ones should not be dismissed. Why is this some bandwagon that everyone is being misled down? Think independently, not with the crowd.

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  • never really sure if this would be good or bad. I couldn't manage all the rubbish of being a partner when I tried it briefly but I don't want to be employed either. im a commitmentphobe and that's why I locum. might be better off finantially as salaried if they offered £100K + and I would get holiday woohoo but I still wouldn't do it as it would seem like a dead end repeating the same day over and over. at least as a locum I can move around do different things and theres the illusion of excitement and things on the horizon.

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  • following from the above I think other than locum work private work is the only way foreward like the dentists with some NHS fee for service work

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  • ......and GPs are surprised about this. Until you stand up and tell the BMA they they are no longer representing what YOU want then this type of program validation will continue. May I also remind you that your employees are contracted to you and redundancies/tribunals will be at you expense. Find a backbone before it's too late

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  • What they dont seem to understand is that if GPs are salaried they have no incetnive to keep practice costs down with purchasing ,lights ,electric etc etc so the actual cost of primary care will increase. what a suprise they will say !

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  • I've been predicting this for years. The truth is, young Drs don't want to be independent contractors any more, they want the security of being an employee.

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  • Excellent so when I am sick I can stay at home then!
    It worked well in the ooh as the work was done for free
    Now costs them a fortune.....

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  • the demise of generla practice as an independent force to improve patient carte in Scotland.Looks like no one has heard of this until after the GPC and 'government' minsiter cooked it up.

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