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Lord Darzi: GP contractors need to be ‘brought into the fold’ to ‘finally complete the NHS’

Lord Darzi: GP contractors need to be ‘brought into the fold’ to ‘finally complete the NHS’

Bringing GP services ‘into the fold’ would ‘finally complete the NHS’, according to former health secretary Lord Ara Darzi, who has suggested all GPs should be given the right to NHS employment.

The independent GP contractor model is ‘frozen in time’ and ‘cannot keep up with today’s demands’, he argued in an opinion piece for the Financial Times.

In the piece, Lord Darzi called for GPs to be welcomed ‘on the same terms as those working in hospitals’ in order to ‘finally complete a joined-up, unified NHS’.

And he said his ‘big regret’ from his time as health minister under the Labour Government between 2007 and 2009 was ‘our failure to persuade GPs to change the way they work’.

The current model of general practice is not set up to deal with patients with multiple, long-term health conditions, and the current state of population health ‘demands modern “hub” facilities complete with routine diagnostic capabilities’, according to Lord Darzi.

He said: ‘Keeping GPs separate from the rest of the NHS is an impediment to reorganising care to meet today’s needs. Offering GPs a right to NHS employment would be a big step forward, as the IPPR recently proposed – and the Labour party has recently backed.’

Lord Darzi, who led an influential national review of the NHS, High Quality Care for All, during his tenure as a health minister, said in the FT that NHS reform is necessary in order to achieve quality care, since ‘to stand still is to fall back’.

He said: ‘Yet some aspects of the health service appear to have been frozen in time. Chief among them is keeping general practice at arm’s length.

‘Most GPs are private contractors and not NHS employees – an arrangement central to launching the NHS in the post-war period.

‘But that model of general practice cannot keep up with today’s demands.’

Lord Darzi also suggested that the current model is worsening GP burnout and, therefore, retention, since ‘without the best new interventions at their fingertips, GPs are having to run ever harder to keep up with demand’.

The surgeon, who holds the Paul Hamlyn chair of surgery at Imperial College London, proposed the a similar idea in 2018 as part of his Institute for Public Policy Research (IPPR) ’10-point plan for the 2020s’.

He said at the the time that the independent contractor model had in some cases hindered the move to primary care at scale.

There had been some confusion over Labour’s position on the GP partnership model earlier this year, with shadow health secretary Wes Streeting offering conflicting opinions.

However, last month party leader Sir Keir Starmer made his position clear when he said the GP partnership model is ‘coming to the end of its life’ and that the NHS needs ‘more salaried GPs’.

Last week GP leaders at the BMA wrote to the Labour Party, urging a discussion in a bid to change this position on the future of the partnership model. The RCGP has also said it ‘strongly resists’ moves to abandon the GP partnership model.

In April, a major Government review by former health secretary Patricia Hewitt recommended a ‘new framework’ for GP contracts, since ‘national contracts’ present a ‘significant barrier’ to local innovation.



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

Darren Tymens 13 June, 2023 1:14 pm

Sorry, Lord Darzi, but remind me which part of the modern NHS is the only part to stay within budget year on year?
Which part of the NHS is the most efficient and productive?
Which part returned to pre-covid performance levels whilst the rest of the system failed despite massive funding boosts?
He is correct – one part of the NHS really is failing, and offers poor value for money.

It’s the bit that isn’t general practice.

Some Bloke 13 June, 2023 1:29 pm

waiting list of 7.5 mln people and growing- isn’t that an illustration of service “frozen in time”.
“GPs be welcomed on the same terms as those working in hospitals”- did he not notice the strikes?
delusional or misinformed? or hidden agenda?

Tim Atkinson 13 June, 2023 1:31 pm

Despite waiting lists as long as both your arms I gather there are full time surgeons up and down the country who are only able to do one list a week. Perhaps he could sort out his own specialty before he starts meddling in someone else’s.

Simon Ottman 13 June, 2023 1:31 pm

I seem to remember how well a centrally funded Darzi clinic went in Leeds last time. Its effect on destabilising the practices in the area still continues to this day (although the Darzi solution to primary care does not ) It was funded to over twice the level of surrounding practices. I’m sure as a surgeon he was/is fine but His ability to impose a solution of Darzi centres on places outside of London was short sighted. Given his past performance on reforming primary care he should keep his opinion to himself

Reply moderated
Centreground Centreground 13 June, 2023 1:43 pm

The current roles are difficult enough -for those that do not wish a salaried role then this date will be the date of resigning from the NHS and the trigger for younger generations to leave the country as large numbers of current managers at all levels within primary care are not of an adequate level of training ,or educational background to manage highly trained doctors ,pharmacists, nurse etc without GP partners taking this responsibility.
The system will implode .
Considering PCNs are taking anyone who is willing to step into various roles including PCN managers despite having lower levels of qualifications, no experience and in some PCNs no oversight is an impending disaster when the partnership model ends and will see GPs moving from posts far more frequently if they choose to stay within this NHS system.

Daryl Mullen 13 June, 2023 1:57 pm

It isn’t the model. It’s the staffing and funding

Michael Mullineux 13 June, 2023 2:01 pm

Vacuous nonsense. About as germane as me offering opinions as to how best to deliver endoscopic surgery.

Ian Haczewski 13 June, 2023 2:20 pm

For goodness sake , do we have to suffer more of this kind of nonsense?

Carpe Vinum 13 June, 2023 2:30 pm

The only thing that keeps general practice afloat is exactly the fact that it sits outside of the main body of the NHS and as such is able to dodge or “interpret” the fatuous nonsense from NHSE/HEE etc.
And it is typical of exactly this that we are expected to listen to a (very highly regarded) expert in minimally invasive surgery pontificate as to how primary care should be run.
The irony is almost deafening

SUBHASH BHATT 13 June, 2023 3:07 pm

Model of salaried gps will destroy doctor patients relationship. It is not your shop any more so you don’t need to come if your nose is running. Practices treat it as a business which offer good service and are rewarded.
Employee is a different scenario.

Peter Player 13 June, 2023 3:18 pm

Where does Lord Darzi intend to find the money to buy all the surgery premises and employ more useless managers to run the practices once the current GP’s lose control?

A Non 13 June, 2023 3:27 pm

This man does not know what he is talking about. His interference in general practice under labour came to nothing. He is a surgeon. Of all Drs in healthcare these people are probably some of the least appropriate to be offering advice on how to arrange general practice. Some of the most offensive and staggeringly stupid opinions I’ve heard about primary care have come from tertiary care surgeons live Mr Darzi. Just about as far removed from run of the mill day to day front door health care as it’s possible to be. Anyone remember the ,now retired, tertiary dermatology surgeon Mr Thomas previously of Chelsea and Westminster and the offensive clap trap he was pushing? Please Mr Darzi, stop giving interviews to the media, put your ego to one side and concentrate on where your sticking your scalpel rather than your nose

Richard Greenway 13 June, 2023 3:44 pm

Stick to laparopscopic surgery, and other things you know about.

Nick Mann 13 June, 2023 3:46 pm

I agree with the BMA, RCGP and the comments above.
Darzi proposes a far more expensive model than the current one, equivalent to double-running of expensive resources and staff (and where are either of these?) . A bit like his failed Independent Sector Treatment Centres (ISTCs) – see the Parliamentary report. And neither does providing better premises entail a wholesale contractual change.

To understand General Practice is complex; Darzi rightly wouldn’t welcome me telling him how to improve his surgical performance.

General Practice is failing because of two things: the lowest international doctor-to-patient ratios, and the absurdity of the (often irrational) drip-feed performance management we are subject to by NHS England.
We have been subject to the same neglect of staff, resources, and funding as the rest of the NHS. The same, real crisis of Parliamentary failure.
Darzi’s belief in the private sector WEF Global Health model has no doubt helped his career, but his super-expensive plans are a rehashed attempt to revive previously failed plans.
GP Partnership is its strength and its basis for cost-effectiveness. ‘Awkward’ GPs are not, and have never been, the problem.
Darzi thinks like a surgeon who works for the private sector. His recipe for general practice is ‘change’ and compliance, not improvement, and he shows minimal understanding of the root problems or their solutions.
By all means provide decent well-equipped premises from which GPs can operate, but stop pretending the answer to our problems is further deprofessionalisation and a tighter bridle. Because it isn’t. It clearly suits Parliamentary control but serves neither continuity for patients nor costs for the NHS.

“The current model of general practice is not set up to deal with patients with multiple, long-term health conditions,” A bizarre and untrue statement. It’s exactly the model that international research deemed the crux of best care for patients with multiple co-morbidities!

Working in big teams in big buildings isn’t integration and doesn’t lead to collaboration. Professional leadership leads to both. There are pros and cons to ease of access to diagnostics etc, but, certainly, the Partnership model should not be the focus. Ask: why is it the focus? I lament that Darzi is advising the Labour Party at all.

Not on your Nelly 13 June, 2023 4:06 pm

Lord Darzi: ” I need to shut up. I’ve failed before because I know about general practice and wasted millions of pounds on the vanity that was the extinct Darzi Centre. I will comment no further on General practice, about which I know nothing, less than Joe Public, who actually use the service. “

Grant Jonathan Ingrams 13 June, 2023 4:18 pm

Those of a certain age will remember the Darzi Centres that he championed. Costs the NHS many £millions before they were closed with a King’s Fund report demonstrating how useless they were.
I also remember him saying something similarly unfortunate about general practice at the time, and having to make an apology and retraction accepting that he had no idea about general practice.

Robert Fletcher 13 June, 2023 4:18 pm

What Darren Tymens said (first comment). I quite literally, couldn’t agree more.

Turn out The Lights 13 June, 2023 4:21 pm

This just proves the kind of ignorant/ arrogant c**** surgeons are.

Anthony Gould 13 June, 2023 4:44 pm

I think general practice would be better served by a salaried service. GP s would then work to the BMA contract with management having to arrange holiday and sickness cover. Funding would increase and GPs could enjoy 8 weeks holiday and able to be off sick without crashing the service.
Also more resilience and pooled funding.
Sorry I believe the partnership model is fading as practices can not recruit partners.
It feels a little like King Canute trying to turn / stop the tide. Embrace such change and make sure there is a good deal before a poor deal is imposed.

Turn out The Lights 13 June, 2023 4:50 pm

The salaried parts of the profession are all voting to strike or are striking so salaried is REALLY working.I dont think they have the money to buy partners out.What ever happen we all know the service has been well and truley stuffed since 2004.Embrace the end of days my friends.

Omair Sheikh 13 June, 2023 4:57 pm

Lord Darzi
I heard you working out in the UAE
This is following the the complete and utter disgraceful failure of the Darzi Centres here in the UK
Maybe your should be health accountable for the millions squandered and you should be made to reimburse the NHS and the UK taxpayer
I strongly feel you need to stop making any suggestions on how general practice should be run here in the UK

David Turner 13 June, 2023 5:27 pm

Who asked for the opinion of a surgeon to sort out problems in primary care?
Has Blair come back on the stage?

Truth Finder 13 June, 2023 5:31 pm

Says the obsessed controller who is clueless in GP land and what happened to those Darzi centres? Closed.

paul cundy 13 June, 2023 9:11 pm

Dear All,
The man is either a complete idiot or working to some other agenda. All the evidence is against diminishing the independent contractor element of primary care. It is true that encouraging the entrepreneur motive in secondary care has failed, but that again is due to incompetent levels of NHS management. If I were a contract negotiator the last thing i’d agree to was payment for potential capacity rather than actual use. If you don’t understand what that sentence means you need to be moved to a new job.
Paul C

paul cundy 13 June, 2023 9:16 pm

Dear All,
I agree, with GP contract holders now being a minority, and a vulnerable one it that (think monopsony), I think the GPC’s focus should be on their exit strategy. Contract holding GP partners are a cohort that cannot sustain successive administrations onslaughts, we need a way out that preserves their investments and current profit levels.
Pau C
D.O.I retiring in March 2024. .

Shaba Nabi 13 June, 2023 10:25 pm

Darren – 1st comment

I wish I could “like” your post a hundred times

Martin D 13 June, 2023 10:44 pm

I know we’re not supposed to play the man but…

Clueless Ivory Tower dick!

David Mummery 13 June, 2023 11:03 pm

Primary Care will be the battleground of the next general election and Labour will be pushing for this model. Labour sees itself as the guardian of the NHS and Lord Darzi will have the ear(s) of Kier Starmer and Wes Streeting … ( in a metaphorical sense)

Dermot Ryan 14 June, 2023 2:13 pm

Clearly scenting a labour victory and positioning himself to be some sort of Tsar. He may be an acclaimed surgeon but knows FA about real life primary care. A salaried model would further erode the little remaining quality there is in health care in the UK.

Paul Hartley 14 June, 2023 8:20 pm

I think he is quite deluded in his belefs

Sujoy Biswas 14 June, 2023 9:00 pm

Oh Darzi, bugger orf back to the upper house and luxuriate in your ermine robes.
The partnership model has kept the NHS afloat while you and your colleagues in the shiny hossies squandered cash and delivered neglegible efficiency efficiency hell the hossies have just about managed email.
£200 to see a Junior Dr in A&E for a sore throat and £25 to see a GP, remind me which model you want?
Your centres and policies were rank failures and you have retired
Just claim your £300 a day and stay quiet — you got it wrong, you don’t understand.

Finola ONeill 15 June, 2023 2:11 pm

Other agenda. The key phrase is ‘the current state of population health ‘.
Population health is a theory developed by the US healthcare companies, brought back to NHS England by Simon Stevens who worked for said US health companies for years, and entrenched onto the long term plan.
It involves a purely healthcare approach to health, including preventable risks like obesity, etc, rather than public health measures which are the appropriate and effective approach, eg Dimblebey government report on obesity measures; advertising and tax, which the government refuses to follow.
IN addition, our life science sector provides £96 billion to our economy; The US companies from Pharma to Genomic tech to Digital want to exploit the NHS to develop new products and this is worth very big money.
They intend to use NHS patients to develop products. Both parties in it up to their necks.
None of this is about patient care or the clear advantages of the partnership model.
It is about control and exploitation.
For that they need the partnership model to end.

Private US genomics company has David Cameron as a paid adviser, Rishi Sunak visited them in California in December 2021 (when chancellor and the economy was tanking form omicron) and the government passed regulations to allow subjects to be recruited via the NHS App as part of a trial of using the App to target NHS patients for research by private US companies. Grail=Galleri
'We are getting a lot of contacts now and we want to prove over the next 6 months that NHS-Galleri was not a one hit wonder and that this is going to work as business as usual.'…/were-transforming-clinical……/GPs-trial-experimental…
'Under the plans, GPs could be offered financial boosts if they trial new drugs or treatments on their patients. '
''Our Life Sciences sector employs over 280,000 people, makes £94 billion for the UK'…/asco-2022-screening-of-patients…

Reply moderated
Thomas Kelly 15 June, 2023 9:55 pm

I think he should be given a chance here to re evaluate. Look at how he rethought his ways after his initial comments and actions towards Elizabeth Bennet. I mean he reflected on this, went out of his way to help her sister Lydia at great personal cost to himself, and even released Bingley. No doubt he will be reading these comments, as he has a real interest in keeping up to date with the primary care developments, and is sure to reflect on things. His centres didn’t work out but time has shown he can change and I think he can be a real ally to primary care in future. If not maybe he can at least host some CPD events at Pemberley.

stephen mann 16 June, 2023 2:02 pm

Lord Darzi, he didn’t know what he was talking about first time round during the New Labour, Tony Bliar regime.
He has clearly learnt nothing from previous policy failures he pushed. Got a peerage though!!

Sanjeev Juneja 16 June, 2023 5:28 pm

Seriously Lord Darzi? After all the havoc wreaked by Darzi Clinics you still feel you could herd GP Contractors and services into the fold, like sheep? No pen will hold GP Services in the fold and no pen can instil sense in words you’ve delivered.