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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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  • "potentially with limits placed on their workload" LOL

    "GPs will only have responsibility for the care they directly provide" LOL

    "independent ‘expert generalist medical advisors’" LOL

    Haven't laughed this much in ages....

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  • What is actually being said that GPs should be treated as employees, but without any of the benefits. If it is so "bad" and scaring the young ones off, why not offer full employee status with sick leave / pension / study leave and all that comes with it - including indemnity. Too costly that way, I thought it might be. So why not stick with the current model and just fund it properly?!

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  • This is the future-a colleague tells me that when the same thing happened in the consultant's contracts, his wife took her work activity log along to her medical director and came out on the same pay for 3/4 the time worked. She was being paid for 3/4 time but doing full time. So at least her time was rebalanced. However she's now back to 13 sessions a week.My advice:start recording a log of what you do and hours worked to present as evidence when ours contracts are changed.

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  • well we can see how it works in Scotland first if they go for it and see if we want it too

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  • What about premises will all partners be bought out?
    What is the incentive to achieve QOF?
    What will be the salary?
    A Dental colleague has just sold out to a national for profit company and hates it,his inept practice manager now tells him how to work and what materials he has to use
    Bottom line is terms and conditions whether salaried or independent contractors.
    Jeremy Hunt said we need to understand why no one wants to be a GP,is he clueless

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  • Anyone got a good alternative that doesn't cost more or depend on more docs which we can't possibly generate for years?

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  • Yes, 7.26pm

    Co-payments and insurance, semi-private (like everywhere else in the world).

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  • Oh boo hoo... All the partners who have milked the contract now crying because no more working 4 clinical sessions a week while getting salaried GP's to do all the work while you're off topping up your paycheck with lmc work, private medicals... Cue the world's smallest violin.... Don't buy the excuse of innovation... Look at the ccgs... Takes then years to make simple decisions... Good excuse yet again to take a time out from clinical work.

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  • I suspect the Scottish GPC see this as an option to protect GP incomes as the last few years have seen expenditure out stripping income.It may also serve to define their role as a GP as a time when we seem to be being delegated more and more responsibility and work. However it will cause fragmentation of the practice team which is a pity. Better to get HMG to fully fund practice staff expenditure , limit and/or reduce contract changes so we can all catch up, and allow us to focus on what we were trained for - medicine . Let the social services look after the social care we are increasingly being asked to undertake.

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  • The Scottish GPC need to hold the SNPs feet to the fire and stop spending NHS money on middle class freebies and on the core service instead,nothing to do with us in England you want independence live within your means

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  • Complaining and sniveling either deserves no response (i.e. if you
    don’t want to eat Mexican food, don’t come, you won’t be missed)
    or a strong response, designating them what they are: malingerers
    seeking compensation for no value delivered. Or, in even plainer
    English, thieves.

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  • The current model of GPs in practices employing their own staff works well and provides cost effective health care -why change it. Unfortunately, the same cannot be said for services run by the health board where there are frequent reorganizations, poor staff morale, high levels of staff sickness and frequent staff change over. Do we really need this in General Practice?

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  • Partners don't want an All-Salaried model.
    Partners don't want an All-Partnership model.

    So what else do the Partners want other than more money?

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  • If I had been offered the consultant contract to embrace salaried status in 2004 I would have embraced it wholeheartedly. (My wife is a consultant so I read both), this despite taking a pay cut. The 2004 contract was a disaster. I am 51 and senior partner, life is entirely miserable and the promised pension based on hard work has gone. My children will not be doing medicine. My advice to them is to work Monday to Friday with weekends off to enjoy life. God knows they will be working long enough. Seven day working is the final nail in the coffin.

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  • I'm all for a salaried model (and I now work as a GP in Scotland)
    This will ensure our indemnity costs stay low (already significant lower compared to England), will to some extent stop the exploitation of salaried workforce by partners ( I can give numerous examples - one being partners who have every weekend as a 'long' weekend forcing salaried staff to do every Monday and Friday as duty docs). There will also be none of this nonsnse where GP partners wait to retire up until their son/daughter/nephew comes along to be parachuted into a partnership... There was some mention of potential bureaucracy under the all salaried model...well the bureaucracy is already incredibly overwhelming in England with CQC, CCG and other 3 letter abbreviations in a partnership model!!...also, I certainly would not like to be responsible for the sick pay of receptionists, admin staff, nurses etc,if I were to be a partner in the future ...bring on the salaried model

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  • What of dispensing practices, premises costs , managers and the whole business . GP practice is not just the staff they are businesses . Switch to this system and you will need to replace many GPs who walk away . Much more detail is required and the choice of walking away the Nhs have a legal contract with GPs .

    This will be the death of Nhs Scotland !

    May be I will take up a telephony post from home for 150k per annum

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  • One of Bevan's concessions to Doctors in forming the NHS was the independent contractual stasis for GP's.It has kept General Practice under the control of Doctors and close to communities ever since .We work in small groups employing our staff in family like businesses with costs for buildings etc kept down because we get to take more money home if we are efficient.One or two computer geeks started to use computers 20 years ago and pushed the rest of us screaming towards computerised records . We learned to type and British General Practice created one of the most comprehensive medical data sets in the world and it all happened by osmosis.We together created the RCGP , the exam and the specialisation of General practice .
    There is a plan in Scotland for Health Boards to take over the employment of our staff, that we will be as close to salaried as possible. That we will become consultants in primary care and that much of the routine work we are doing will be done by other Health care professionals.Firstly the plan is not specific about any one idea in it .What is the routine work of a GP ? Where are all these allied health professionals? It is quicker to see me than a physiotherapist( often you just get a handout), a psychiatric nurse, a psychologist,a councillor. Working in clusters? I could make a guess that this is about spreading the work force to where it is needed, but again an idea short on detail.
    My practice would probably want to preserve the status quo. I am well aware that in parts of busy urban Scotland and our more isolated areas that anything would be better than the status quo. When we were saddled with out of hours many urban practices had created co-ops which had solved the problem and I remember my frustration listening to people who had no idea what our lives were like in semi-rural Scotland .
    The status quo is not an option, but next time people are romanticising about the days of matron and the consultant as the team leaders in secondary care, think about what is going to happen to General Practice. Clusters will grow and become massive as they already are in England , at first perhaps run by doctors , but that will rapidly become impossible. Then it will be big business and we will be employees , grocers to Tesco's.Everything will be neatly packed but never quite taste the same again.We will be audited and told who to review , who can be seen by someone else, how many to see in what time. We will belong to nothing and the personnel relationships which are the magic of our therapeutic power will be lost.Patients will loose their Doctor who has overall responsibility for their care , who advocates for them when the system lets them down. Prescribing is dangerous enough with the confusion between primary and secondary care , what will it be like adding in allied health professionals with an innocent script for ibuprofen.
    The Road shows have been stages for politicians, not exchanges of ideas. I would suggest we go in the opposite direction and use the model of the independent contractual stasis as the solution to the problem. Give practices the resources to employ the staff they need, their own physiotherapist, pharmacist, psychiatric nurse , district nurse .Create bigger teams from the successful teams that already exist.We need to remember how successful the NHS is at the present moment, it looks after 70 million people in one of the most socially divided countries in Europe and in light of that gets world class results .Is their anybody else out there who smells a rat!

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