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GP autonomy ‘will be lost’ under Scottish contract, warns former RCGP chair



GPs will lose their autonomy to employ and manage their practice team under the new GP contract, the outgoing RCGP Scotland chair has warned.

The new Scottish contract will see a number of healthcare professionals employed directly by the NHS, but attached to GP practices. The NHS will also pay expenses for all staff from 2020 if the contract is voted through by the profession.

Under the agreement, GP partners will earn a minimum of £80,430 by April 2019, and there is an intention that no GP will own their premises by 2043.

But Dr Miles Mack, who stepped down as RCGP Scotland chair this month, warned that the contract could lead to a loss of autonomy.

He wrote on Twitter: ‘The autonomy GPs have to employ and manage their team appears will be lost in the new #GPcontract.

‘We will be giving this up with no assurance on workload control and T&Cs far short of those enjoyed by Consultants. Seems odd…’

Local GPs have also warned that this could ‘stifle’ their autonomy. 

Dr Iain Kennedy, executive partner of the Riverside Medical Practice in Inverness, said: ‘We are successful and thriving despite the GP crisis, our income is better than average and our morale is very high.

‘We dread the thought of having board employed clinicians because we can’t even get our midwives to do flu vaccinations.’

Dr Kennedy added that the new contract ‘will stifle our ability to innovate and to change and stifle our enthusiasm and the talents of our staff’.

Dr Alan McDevitt, BMA GP Committee chair for Scotland, agreed that there will be less opportunity for entrepreneurial GPs ‘to some extent’ but insisted there is ‘no intention to destabilise practices’.

He told Pulse: ‘There are not a huge amount of practices in Scotland that have a huge variety of additional services. There is an expressed clarity you don’t have to be an entrepreneur to do well as a GP.’

But he added that there will still be some ‘additional services for GPs to choose to do’, such as contraceptive services.

Dr McDevitt also said: ‘Our perception is younger GPs appear to be more up for all the elements of [the new contract] because successful older GPs don’t have problems to solve.

‘This is about creating a sustainable model and it’s about how we survive.’

The contract will have a two-stage reform of the funding formula, with ‘phase 2’ offering a pay progession and a guaranteed income range – similar to that of consultants – from April 2020.

But the BMA and the Scottish Government have already said that they may have to adjust the contract as HMRC could consider the new model to be a salaried service.

GPs will be able to vote on whether to accept the new contract following a special conference for LMCs on 1 December.

The RCGP has been approached for comment.