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GP contract has led to ‘hierarchical’ profession

By Lilian Anekwe

The 2004 GP contract has turned general practice into a ‘hierarchical' profession with simmering resentment between partners and salaried GPs, a new analysis finds.

A wide-ranging report prepared for the Department of Health on the effects of offering financial incentives on GP behaviour found that the growth of salaried GP employment had meant general practice teams were often ‘characterised by hierarchical relationships'.

The researchers, including influential academics from the National Primary Care Research and Development Centre, said the rewards from high QOF achievement had not been fairly distributed between GP partners and salaried GPs – leading to ‘tensions'.

‘We identified tensions arising with respect to perceived inequalities in relation to workloads and rewards. Salaried GPs expressed concerns about the distribution of additional income from the QOF and its relationship to effort.

‘There was evidence in our study of practices becoming increasingly hierarchical in nature. GP partners were generally above salaried GPs in both the formal and informal hierarchy.

‘The increasingly hierarchical nature appears to be leading to differential GP status in many practices. Although many GP partners described the salaried GPs they employed as valued colleagues by no means all did this.

‘The comments by salaried GPs suggest they perceive their treatment as inferior to partners and as unfair in many cases. This state of affairs appears to be leading to two tiers of GP professionals.'

Study leader Professor Ruth McDonald, professor of healthcare innovation at the University of Nottingham, said: ‘One of the unintended consequences of the QOF has been that there are more salaried GPs, and many feel their financial rewards from the QOF are not commensurate to their efforts.'

GP contract has led to 'hierarchical' profession