The shadow health secretary has said he wants to ‘tear up’ the ‘murky, opaque’ GP contract, while considering abolishing the GP partnership model in favour of a salaried service.
Speaking to the Times on Saturday, Wes Streeting also laid out plans for patients to self-refer to secondary care, with GPs no longer the ‘sole gatekeeper’ for specialist services.
He added that he is willing to take on the ‘vested interests’ of the BMA, saying he will listen to the profession before making any changes, but that he wants to do ‘what is right for patients’.
Mr Streeting also said that he wants to shift funding from hospitals to the community.
His comments were met with anger from GPs, who said that the shadow health secretary displayed a misunderstanding about primary care.
This is not the first time Mr Streeting has clashed with GPs, having last year said that there was a culture of GPs receiving ‘something for nothing’, and laying out plans to bring in stringent waiting times.
In his interview with the Times, Mr Streeting said that the profession needs an overhaul, and potentially a move to a salaried service. He said: ‘The truth is that the way that GP practices operate financially is a murky, opaque business. I’m not sure that people can honestly say exactly how the money is spent or where it goes. And from my point of view, as someone who wants to be a custodian of the public finances as health secretary, that would not be a tolerable situation.
‘I’m minded to phase out the whole system of GP partners altogether and to look at salaried GPs working in modern practices alongside a range of other professionals.’
Such a move wouldn’t be popular with GPs, and Mr Streeting acknowledged that it would be opposed by the BMA. However, he said: ‘Nye Bevan famously said he had to stuff their mouths with gold because the BMA opposed the foundation of the NHS. There have always been people within the system who oppose fundamental change which, decades later, is widely accepted. I’m always prepared to work with people.
‘We’re going to be actively consulting on this. I recognise it will be a big change. I want to listen to the profession and take people with us but, most importantly, I want to get this right for patients. The NHS is so broken, we do have to think radically.’
The shadow health secretary also said he wanted patients to be able to bypass their GPs for referrals. He said: ‘Sometimes it’s pretty obvious that you don’t need to see the [family] doctor. I had a lump on the back of my head, during the pandemic. I needed to see a dermatologist but in order to get an appointment with a dermatologist, I had to go through the GP. What a waste of my GP’s time. I think there are some services where you ought to be able to self refer.’
He said that vaccinations are ‘money for old rope’ for GPs. He said: ‘I’m convinced that pharmacy has a big role to play. This is where competing interests among providers might not always work in the interests of patients. I can well understand why there are GPs who look with anxiety at pronouncements from politicians that community pharmacies should be doing more vaccination or more prescribing, but that’s because they’re thinking about their own income and their own activity.
‘Vaccinations are money for old rope, and a good money spinner, and not unreasonably GP partners are thinking about the finances of their own practice. That’s totally reasonable but what matters to the patient is fast, accessible care, wherever that is.’
Mr Streeting’s comments were met with anger from GPs.
Dr Lizzie Toberty, GP lead at Doctors Association UK, said: ‘There is little evidence that patients unable to obtain a GP appointment turn up in A%E. If you need oxygen, monitoring, surgery, have a suspected heart attack or are too ill to cope at home, your GP cannot help. A&E is very busy because lots of patients are very sick, there are huge staff vacancies and there is a lack of hospital and social care beds.
‘There are so many misunderstandings underpinning Wes Streeting’s plans, I wonder how much time he has spent in primary care. He will not be able to fix the NHS without understanding the causes of the problems.’
Dr Ed Turnham, a GP partner in Norfolk, wrote on Twitter: ‘The partnership model of GP has been the jewel in the crown of the NHS for 70+ years. It’s failing because of underresourcing, not because the model is fundamentally flawed. It’s not perfect. It could be substantially more efficient.
‘But if you kill off the independent contractor model in search of that extra efficiency, my best guess is that you will end up with something much worse. 70+ years of success down the drain. And it would be extremely hard to get it back.’