GPs should give up their independent contractor status and become NHS employees, an influential GP academic has suggested.
Professor Azeem Majeed, head of the Department of Primary Care & Public Health at Imperial College London and a part-time GP in South London, also said that primary care should drop capitation-based funding in favour of methods that link workload more closely to funding.
The leading academic’s suggestion – in an editorial published in the Journal of the Royal Society of Medicine titled ‘General practice in the United Kingdom: meeting the
challenges of the early 21st century’ – comes after Professor Clare Gerada, outgoing RCGP chair, said she would be examining GPs giving up independent contractor status in her new role as clinical chair for primary care transformation in London with NHS England.
In his article, Professor Majeed said: ‘Under the current capitation-based funding method, GPs face unrestricted demands for their services and on their time while having to operate on a fixed budget.’
This increases their workload, he added, and increases pressure on other parts of the NHS, such as emergency departments.
He said: ‘Although capitation-based budgets have been the cornerstone of UK general practice for many decades, it may be time to consider modifying this method of funding primary care in favour of methods that link workload more closely to funding.’
However, his most ‘radical’ step was to question GPs’ independent contractor status.
He said: ‘An even more radical step would be for general practitioners to give up their independent contractor status and become NHS employees under similar employment terms to those offered to doctors working in acute, community and mental health trusts. This could potentially allow general practitioners and their staff to be employed on national NHS terms of service and overcome the divide that is being created between self-employed general practice principals and salaried general practitioners.’
Other options considered by Professor Majeed include the incorporation of tariff-based methods of funding in place of or in addition to capitation payments, the establishment of ‘super-partnerships’ involving the merger of general practices and greater collaboration between practices via the formation of networks or federations.
Professor Gerada told Pulse earlier this month ‘it may be that we have to look at some thorny issues’. She added: ‘We may have to examine the independent contractor status and decide what the pros and the cons of it are.’