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Labour to ‘tear up’ GP contract and consider move to fully salaried service

Labour to ‘tear up’ GP contract and consider move to fully salaried service

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.’



Please note, only GPs are permitted to add comments to articles

Dave Haddock 9 January, 2023 10:44 am

Nail, coffin.

Turn out The Lights 9 January, 2023 11:09 am

Red or Blue doesnt really matter.

Richard Brown 9 January, 2023 11:09 am

Created by Labour. To be killed off by Labour.
Showing rank ignorance about how Primary Care works. Isn’t he just the safe custodian of the Health Service we all want.

Michael Mullineux 9 January, 2023 11:11 am

Demonstrates why History Graduates are ill equipped to solve the problems facing the NHS completely ignoring the fundamental issue of a toxic antagonistic environment leading to rapidly decreasing GP numbers. Rather than congratulating GP’s on the success of vaccination programmes, chooses to choose to offer this to pharmacists, who are also in short supply and certainly won’t deliver this any more cheaply. I despair.

Sam Olatigbe 9 January, 2023 11:11 am


Paul Charlson 9 January, 2023 11:22 am

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.’

The lump on his back was probably Kier Starmer. Seriously though, the lump might easily be dealt with in Primary Care. Take a look and either
1. Cosmetic – go private or leave alone
2. Something sinister – refer maybe needs a surgoen not necessarily dermatologist
3. Minor but needs analysis to ensure OK – why not resurrect proper minor surgery in community? – patchy service but could be done at a lower cost than in hospital – this service is patchy .

Im a locum these days but I think there is still merit in a partnership model , the risk of salaried is a proliferation of managers and costs

Mr Marvellous 9 January, 2023 11:24 am

There are so many flaws to this, it’s unbelievable.

Where are the estates going to come from? Massive building buy-back?
Does he really think that making Partners into Salaried GPs will increase the amount of patient time available? (Hint: No!)
How is he going to magic up 2 GPs each for the Partners pulling 60-70h at the moment?
How many extra managers will be required to replicate the management work done by Partners?
How’s he going to replace the 20pc (a very conservative guess) of GPs that will simply walk off?

This dangerous fool will break the NHS even faster than the Tories (which may not be a bad thing, but that’s a different discussion).

Fedup GP 9 January, 2023 11:27 am

Don’t care. Leaving. Fu*k ’em.

SUBHASH BHATT 9 January, 2023 11:27 am

politicians tinkering continue. Salaried gp will prove very expensive to gov.
Gps don’t count hours they work now..

Nick Mann 9 January, 2023 11:29 am

Wrong prescription for GP, showing lack of any deep understanding of how GP works and supports the wider health system. Random, off-target and ill-advised. Return to a profession-led NHS is part of the solution; ditching the NHSE-led unevidenced micromanagement of our clinical activity, which now comprises probably 25% of GP work and which in large part is unproductive, serving only the population of managerial dashboards.
Independent contractor status has been key to the successful function of General Practice. Pronouncements to abolish this in favour of a more malleable salaried service simply play into the ‘disruptors’ misinformed narrative which we are familiar with from Tufton Street.
These proposals from Streeting would cause further harm and an even larger GP workforce gap.
Something-for-nothing is what GPs have been doing (for too long), not what GPs have been receiving.

Stephen Fowler 9 January, 2023 11:40 am

Perhaps read and digest this document, Wes, rather than just enjoy listening to the sound of you own ill informed voice;

Perhaps time to accept that experienced doctors know more about running a health service than history graduates

Ian Haczewski 9 January, 2023 12:07 pm

Absolutely unbelievable, the death knell of general practice , it’s about time they trusted those who do the job to look for solutions . They have no idea at all .

Iain Chalmers 9 January, 2023 12:19 pm

After 30 have gone. Was partner & loved looking after building, staff, patients, working with # arm or ankle etc NOT

Did salaried for 2 years and followed my contract to letter no extras, no staff shenanigans to sort, no building management, illness meant not my problem either.

Still walked as both shit just degree of shit that varied.

Had some real doozras managing the NHS & even in the wings this chap has obviously got his knowledge about Primary Care from Ronald McDonald.

PS rather have my vaccine reaction at GP than in Boots

Douglas Callow 9 January, 2023 12:40 pm

Political men in a hurry rarely have grip and invariably make thigs worse
In this case he appears to be both ill informed and happy to sabre rattle
All the promises around sorting out the grossly unfair Pensions anomalies to retain staff now seem to have been forgotten
The calibre of our political leaders seems to get worse by the day

Adam Crowther 9 January, 2023 12:50 pm

😩looking forward to higher real terms hourly pay and being home in time to vote for him to eat exotic offal in I’m a celeb 2027!!! Perhaps we can have a consultant contract and work privately in our own time seeing the stuff specialists can’t get in beyond their 6 year self referral waiting lists!

DrC H 9 January, 2023 12:58 pm

From a GP who escaped this madness now living in Aus.
What on earth are they thinking? The current heavily-vetted waiting list to see a specialist that is already a year long will suddenly be 5 years or longer as a tidal wave of undifferentiated problems demand to see a specialist, who will only manage the issues strictly within their area of expertise. Unless you are very rich, getting ill in the UK is about to become a very scary prospect indeed. GP numbers will continue to free-fall. The British public are about to find out just how expensive health care in the global free market actually is.

Richard Greenway 9 January, 2023 1:01 pm

Its a shame when the oposition sound just as rabid as the incumbents -with no understanding of the currrent system.
If there is a serious offer to buy out existing GP estate, and take on all staff contracts, employer liabilities, data protection liabilities, financial liabiltiy CQC management responsibility – then lets have this out in a constructive way.
But if this is just another dig – please don’t.

Thomas Robinson 9 January, 2023 1:19 pm

May I raise a point of historical accuracy

I think the stuffing of mouths with gold quote, referred to our consultant colleagues, not GP,s

A GP partner with 2K patients consulting average 4-5 times year earning 100k is getting £ 10 gross, £ 5 net per consultation, of course divided by the number of problems per consultation presented. About the same as a soy latte and bun. Wes is saying he can improve on that, with the caveat he doesn’t actually understand any of it.

Astonishingly, it appears the Labour Party has no-one to explain it to him either !

Nicola Williams 9 January, 2023 1:26 pm

offensive and insulting . He doesn’t know ” how the money is spent or where it is going ” – he’ll soon know when private companies take over and costs go through the roof, and the worried well self refer to all and any specialist they can . good luck !
while we are talking about where money is going … PPE contracts , ministers expenses , ministers second jobs , ministers enhanced pension …….etc etc

David Banner 9 January, 2023 1:39 pm

I think Streeting is just dabbling in a little populist sabre-rattling.
The world and his wife are giving GPs a good kicking right now, so he’s simply egging on the mob to burn the witches.
Once he is in post in 2024 reality will bite. The mandarins will sit him down and quietly explain why suddenly abolishing partnerships would be financially and politically suicidal, but the current plan of slowly starving them into extinction is coming along splendidly.
Why squander billions buying out practices when you can just allow them to fail? Why kill unpopular GP scapegoats when you can blame all your political failures on them?

Stephen Savory 9 January, 2023 2:27 pm

“The truth is that the way that GP practices operate financially is a murky, opaque business.”

Forgive me, but I’m suffering acute schadenfreude:

Turn out The Lights 9 January, 2023 3:03 pm

A History Graduate.Wonder what Grade he got.

Aman Samaei 9 January, 2023 3:24 pm

Boris said and bought votes by : One of the most enduring images of the Brexit campaign was the slogan: “We send the EU £350 million a week – let’s fund our NHS instead” emblazoned on the side of the Vote Leave campaign’s bus.
Wes also trying to buy votes, But he does not understands what he says, only slogan like Boris who ruined the NHS and Wes will abolished the whole NHS by this plan.

John Clements 9 January, 2023 5:05 pm

To quote Uncle Monty in Withnail and I

‘Shat on by the tories, shovelled up by Labour’.

Nothing changes.

Sam Tapsell 9 January, 2023 5:18 pm

Sounds like a sensible political statement, what else can he say?
Pay for appointments?
Pay for all prescriptions?
He wont get elected unless he promises reform alongside funding.
I think a salaried GP service role sounds quite nice:
No longer gatekeeper / employer / holiday and sick cover etc.
Maybe us GP partners are already a dying breed, and this is just looking at direction of travel and calling it a plan.
Isnt this similar to scotland and wales where failing practices are taken over by health boards?

Mark Lynch 9 January, 2023 6:04 pm

Wes Streeting’s policy adviser is a GP Trainee, Dr Tom Gardiner.
I’m not joking.

Cameron Wilson 9 January, 2023 6:04 pm

He can say whatever he wants but remember Wes, you need us far more than we need you!
Thought Matty Boy took the biscuit but this chap looks to set new levels of incompetence !
At least we know what we are up against, perhaps we should start looking after ourselves and have a Plan B, after all it can’t be worse than anything that he will come up with!

Liam Topham 9 January, 2023 6:12 pm

he may have been enjoying a Camberwell carrot given his loose grip on reality

A Non 9 January, 2023 6:30 pm

This guy is basically talking about shutting down general practice and getting rid of it. He’s going to get a bunch of ‘salaried’ GPs instead. They’ll be employed and managed by ..somebody in the NHS (maybe hospitals?) and there’ll be other people doing the work too.. he isn’t sure what that work is anyway…just that it involves “stuffing their mouths with gold” and he wants to ‘sort them out’. This pillock is going to be the next health minister. General Practice is about to get shut down and replaced by an utter mess. He’s hoping to transfer a lot of money out of hospitals into the community. He’s going to need to. This sounds incredibly expensive. Its just sad it’s going to make everything completely shit, he’ll totally screw up, move to another job and be forgotten

Dave Haddock 9 January, 2023 7:23 pm

On the upside, Wes Streeting’s version of Primary Care will create a huge opportunity for private practice outside of the NHS for those with clinical experience and a bit of business nouse.
Fob off by bored pharmacist or nurse who has “done the course”, vs £100 to see someone running their own business and who knows what they are doing?

Rebecca Connell 9 January, 2023 9:31 pm

With declining Gp numbers this is one sure plan to remove all the over 55’s who will retire, removing a wealth of experience.
Clog the system with self referrals , mis directed and inappropriate. Increase cancer deaths from all the delayed diagnosis, no more 2WW as you’ve already put yourself on the 5year waiting list.
Waste even more money than the current governments nhs plan , pcn’s and the bureaucracy.
Fund the gp’s directly we know our populations we known their needs, and we will spend the money wisely without waste or added levels managerial cost.

James Bissett 9 January, 2023 9:57 pm

As usual the number of responses speaks volumes,I think that you all know what really is coming next for GPs.
This poor fellow may not have all the knowledge yet but he is saying all the things that the public wants to hear.
Once they get rid of Mr Starmer and slot in someone electable the Torries are out.
Winter is coming

David Mummery 9 January, 2023 10:39 pm

Sadly with the current lack of enthusiasm for partnerships and imminent retirement time-bomb of large numbers of GP partners the only trajectory is down., until some sore of GP ‘liability crisis ‘ likely occurs, probably most likely related to estates. Then the question will be : would you prefer to work salaried for a large commercial Primary Care provider ( the answer is no, you will be exploited), or does a new deal for a ‘new category’ of NHS employed GP need to be well negotiated with limits on workload and a ‘PA’ model consultant like job plan with non clinical work like CPD and teaching etc ‘built’ into the model. This may turn out to be the best option in the long term but would need skilled and hard negotiation. Labour are going to win the next election.

David jenkins 10 January, 2023 12:54 am

Nicola Williams

don’t forget house flipping, £100 + per roll wallpaper, duckhouse painting, moat draining etc etc etc !!

David jenkins 10 January, 2023 1:13 am

Sam Tapsell

in wales, the practices taken over by the LHB (welsh equivalent of PCT), have decided to tax ALL locum or agency staff at high rate. they apply HMRC IR35 to ALL agency staff, contrary to rules/guidance produced by HMRC themselves. all are treated as “employees for tax purposes only”, so – no sick pay, holiday pay, pat(or mat)ernity pay etc, and no car or other self employed allowances. in short, you lose all the advantages of being self employed, but get no advantages of being an employee.

even HMRC say it contravenes their guidelines.

so what, you might say ?!!

result is that ALL locum fees for managed practices in wales are increased to take account of this, and ALL agency fees re higher for managed practices.

multiply that by the whole NHS workforce, and see whether the deal you currently have is good.

any politician abandoning the partnership model will need extremely deep pockets !!

p.s i do know a bit about it – i have been a GP since 1977, retired, but still doing locums at age 73 !

Centreground Centreground 10 January, 2023 10:24 am

My children sent me this -they followed up by stating they are along with their friends actively looking to move abroad to practice medicine as there is no other response to such nonsense

Muzakir Majeed 10 January, 2023 11:59 am

Lessons for professional life.
1) if you don’t respect yourself, no one else will.

2) If you throw peanuts, you will attract monkeys. (Converse; if you pick up peanuts, you may be mistaken for monkeys.

Time for some self respect, and not be walked over by fools and failed politicians

Long Gone 10 January, 2023 1:12 pm

Stroke of genius. After all, it’s worked so well with hospital based medical staff hasn’t it?
I recommend “Why we get the wrong politicians” by Isobel Hardman.
Absolute negligent idiots with chronic relapsing Dunning Kruger Syndrome.

Long Gone 10 January, 2023 1:22 pm

“I want to get this right for patients”
So start by getting it right for the people looking after them. “Your customers will never be any happier than your employees.” —John DiJulius, The Customer Service Revolution.
“Put your oxygen mask on first.” (Though admittedly this is possibly counter-intuitive to a mono-synaptic MP.)

Slobber Dog 10 January, 2023 1:25 pm

I never expected Labour to be an enemy to healthcare.
Perhaps it’s really about control and less pay.

Douglas Callow 10 January, 2023 2:38 pm

Sadly the private investors are being told by Wes they will be safe under labour

Long Gone 10 January, 2023 2:55 pm

Slobber Dog – Labour aren’t the enemy of healthcare – necessarily. But to them, we are a bunch of privileged high earners with most likely a private education. (For the record, I went to comprehensives and did a higher degree with the OU – both Leftish inventions, so thanks Labour.)
The mouths that Bevan had to hold his nose to “choke with gold” were the royal colleges of the hospital consultants (the RCGP was yet to be born then). Charlie (aka “Corkscrew Charlie”) later Lord Moran of the RCP did the deed on us. A maximum part-time contract did the choking of the consultants. And the rest is history. Julian Tudor-Hart in A New Kind of Doctor is well worth a read. He of Inverse Care Law fame.

Mo Sul 10 January, 2023 3:39 pm

GPS should not be dealing with these vaccine refuser ? Allergic reaction should go to a&e . No extras or extra task . Not covering sickness .. not voting labour

Just Your Average Joe 11 January, 2023 12:43 am

It’s true Wes is being advised by a GP trainee.

Blind being led by the inexperienced, with a large dolop of private healthcare providers whispering in his ears.

Dismantle the best part of The NHS at your peril, as you will need to double the number of GPs and places in medical schools, but take 10 years to develop.

Hospital wait times will rocket with self referrals, so truly sick patients will suffer and risk patient harm.

Can’t vote Conservative and Labour mirror image.

No other party can win right now. The country is screwed and will cry in the memory of the NHS when health care costs bankrupt anyone surviving the cost of living crisis

Caroline Dain 11 January, 2023 11:04 am

Please see this link. Responses due before 30 January. Some small but useful NHS pension changes proposed.
This consultation document proposes changes to the NHS Pension Scheme:

Consultation to
1) Propose new retirement flexibilities:
2)Aligning the timing of CPI inflation rates used for revaluing pension benefits and the annual allowance tax calculation

Bob Hodges 11 January, 2023 2:41 pm

I’m a professional critic of politicians and their stupid ideas, but this ‘idea’ is incomprehenisble, and the magnitude of its rejection of anything recognisable as reality by anyone who’s ever worked in healthcare is breathtaking.

The flaw in democracy is the ability of these idiots to escape the future consequence of their actions, and being held to account for their failures, on the grounds of ‘unintended consequences’.

There is a massive difference between ‘unintended consequences’ and ‘entirely foreseeable consequences to anyone with half a brain’.

Until this country is routinely able to tell the difference, they we will continue to suffer worse governance.

Chuck S 28 January, 2023 10:45 am

He has a lump in the back of head and thought he needed to see a dermatologist? If Gps referred all benign lumps, the health service would crack on day 1 and melanomas would take 3 mo ths to be seen.

Thata exactly why you need GPs, especially gp partners who are the gate keepers.

Nicholas Bulmer 24 April, 2023 12:12 am

Not got a clue. Just another moaning politician pandering to an electorate that doesn’t appreciate what’s given freely. Wes Streeting, join the long long line of politicians who don’t know, don’t care, know they dont know, don’t care they don’t know, know they don’t care they don’t know, and yet they run, run run, to join the gravy train called parliament, that circus run by clowns.