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London should consider developing GP ‘salaried service’, finds report

London should consider developing a ‘salaried service’ for general practice because of the high numbers of young GPs shunning partner positions, a report by the London Assembly’s health committee has recommended.

The report, set up by London’s governing body and chaired by Labour MP and GP Dr Onkar Sahota, makes five recommendations, including that NHS England (London) investigates the reasons for low GP morale, develops new alternative practice models, boosts GP numbers and invests in new premises.

It also says that there was ‘a case’ that a salaried service would ‘extend the provision of services’.

The report estimates that around 16,000 more GPs will be needed nationally than are currently available by 2021, and that almost 16% of London GPs are over 60 years old.

It warns that ‘if large numbers of GPs take early retirement, London could be desperately short of doctors,’ and follows a survey yesterday that found that more than half of GPs are considering early retirement.

The recommendation that London takes on a salaried service follows a declaration by NHS Hull CCG that they are looking at a ‘wholly salaried model’, and comes at a time when NHS England is looking to devolve responsibility to localities either through co-commissioning or even giving Greater Manchester councils and CCGs full responsibilities for the NHS and social care budget.

The London report analyses the pressures that general practice is under and suggesting strategies for boosting services at a time of scarce resource and rapidly expanding patient numbers.

In a section on workforce challenges, the report references seven Pulse stories highlighting issues such as high vacancy rates and that young doctors are increasingly opting for salaried or locum positions.

It also references the story from last year that about 4,700 doctors a year applying for certificates that would enable them to work overseas.

On the issue of salaried GPs the report states: ‘There is a case for NHS England (London) to consider developing a salaried GP service in London to extend the provision of service where needed, and to facilitate a career choice which newly qualified GPs are increasingly making.

‘The workforce in general practice has seen a noticeable shift towards increasing numbers of salaried GPs since the turn of the century. There was a 12-fold increase in salaried GPs nationally between 2010 and 2025. Practices also experienced increases in locum fees over the same period, averaging 9.5% in 2012. The rise in locum positions has implications for care continuity and quality, and for the long term stability of GP care provision.’

It adds: ‘Anecdotal evidence suggests a growing reluctance to take on the liability of owning a practice, employing the staff and the extra work that comes with being an employer, along with the workload demands. Young doctors are opting for salaried or locum positions.

Dr Sahota said: ‘As many as 90% of all the consultations in the NHS are through GPs – our family doctors we know and trust. Yet in London we are seeing cracks and fractures which, if left unattended, could have disastrous results for patients and doctors.’