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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)

  • "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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