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All GPs will go salaried to the detriment of patients, predicts senior GP leader



General practice will be staffed by salaried-only doctors in the future, a senior GP leader and NHS England advisor has said.

Dr Michael Dixon, College of Medicine chair and NHS England clinical champion for social prescribing, said this comes as young doctors are increasingly avoiding taking up partnerships.

But Dr Dixon, a GP in Cullompton, Devon and the former chair of the NHS Alliance, said it is patients that will be disadvantaged when this happens.

Speaking at the Westminster Health Forum on primary care co-commissioning yesterday, Dr Dixon said: ‘I think we will become salaried but I think we will lose an enormous amount… I think we will lose the dynamics… of having your doctor, your advocate, your bloke that’s there for 35 years.’

A straw poll of delegates taken earlier in his speech found that only four of around 160 delegates had a regular GP that they see, however 80% would like one.

But he said young doctors don’t want to be come partners as they can make ‘much more money by being salaried GPs’.

He said: ‘They also get headroom. They can go off and do education for half a session a week. They don’t want to be having practice meetings once a month, all night, which we do, business away days every few months and all the rest of it. They don’t want it.’

His comments come after a Pulse survey revealed that only one in five GPs thinks the partnership model will still exist in 10 years because of ongoing pressures and future liabilities on practices, including the rising cost of legal claims.

Dr Dixon added that there is currently a good balance in primary care with GPs ‘running the show’ while also being ‘shackled by contracts and performance indicators that makes sure that we do the NHS’s bidding’.

He said: ‘I turn the lights off as I leave surgery at night, make sure the roof’s not dripping and make sure that if the staff doesn’t come in in the morning I ring up someone else to do it. 

‘There’s a different ethos and I think those of you in the private industry here will probably agree with that between running your own shop and having it done for you.’

In the same speech, Dr Dixon also commented on the handover of general practice commissioning responsibilities to CCGs, commenting that it had been ‘chaotic and rushed’ and with a lack of ‘proper support from NHS England’.

He said that this comes as half of all CCGs are now have full delegated responsibility for commissioning general practice in their areas.

Are all GPs headed for a salaried model?

A recent report from the House of Lords Committee on the Long-term Sustainability of the NHS advised the health service to explore the option of putting GPs under its ‘direct employment’, adding that that the ‘small business model’ of general practice is ‘inhibiting change’ that’s needed to secure the sustainability of primary care.

The report quoted RCGP chair Professor Helen Stokes-Lampard as saying that ‘whilst personally I love the partnership-led model of general practice, I know it is not likely to be fit for the long-term future’ – comments she later clarified.

A Pulse analysis last year showed a growing trend towards partners being forced to give up their contractor status, amid underfunding of the model.

Recently, GPs at four practices in Gosport moved to salaried positions under the local trust, in an effort to shore up finances and last year, Pulse revealed that six areas in England, Scotland and Wales are planning to move towards mass salaried models