GPs would be told how to treat their patients by the state if they were to give up their independent status, says a GPC negotiator in response to a call from Professor Clare Gerada yesterday for the profession to become salaried employees of the NHS.
Dr Peter Holden said that GPs represent the last group of medical practitioners not to be ‘enslaved by the NHS’ and that removal of their independence would ‘emasculate’ the profession and hamper recruitment.
RCGP chair Professor Clare Gerada called for a historic re-evaluation of the independent contractor model of general practices in her final address to RCGP members at the college’s conference yesterday in Harrogate.
She said that the time of GP practices working in isolation ‘has passed’ and called for a move towards provider organisations led by GPs to reduce fragmentation of care and reduce costs.
But Dr Holden said that he fundamentally disagreed with Professor Gerada and warned it would harm the doctor-patient relationship.
He said: ‘I disagree, and one of the fundamental reasons I disagree is the same reason our grandparent’s generation disagreed in 1947. If the state controls the profession it controls what is the best advice to the patient.’
‘The bottom line is that our grandparents generation had it right, and the reason why there was such resistance was because they did not believe that the state would not interfere in the doctor-patient relationship – and I think that the antics of recent years proves that to be true’.
‘It is time people realise that medicine is not the NHS and the NHS is not medicine, and the last significant group not enslaved by the NHS are GPs.’
Asked what was the worst that could happen if GPs lost their independent contractor status, Dr Holden said it would be the Government dictating how doctors treat patients.
He said: ‘We would be told how to treat patients. We would not be able to speak out on the patients’ behalf. It would emasculate the profession. At the moment, if I believe something is right for patients, provided my peer group agrees with me, I can do what is needed.’
He added: ‘I have no desire to be anybody’s employee and I never have had. That was part of why I chose general practice. I am freer to organise things the way I wish to organise them, yet still give patients a cracking service. I went to the Frank Sinatra school of medicine – My Way.’
In the face of calls from Professor Gerada for 10,000 more GPs, Dr Holden also said her suggestion would hamper any drive to increase the GP workforce.
He said: ‘I think there would be fewer people becoming GPs. Because actually there are a proportion who once they have seen the freedom of being an independent contractor, actually they are quite attracted to it. I think that you will get a proportion [of graduates] entering the NHS, and a proportion who just emigrate - and if I were a young man, I would just emigrate.
However, he added: ‘But if you wish to salary me, that is fine. I will not be in on Monday morning with my sore throat and I will walk off the job at 6 o’clock even though the waiting list is full.’
‘I feel quite strongly that the Government doesn’t realise what a bargain it has got.’
‘You have to remember that if you are an independent contractor your job description is task-delineated. If you are a salaried employee, your job is time-delineated. That means that you will underbook, you will not get the through-put that we deliver. I think it would be disastrous for patients.’