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‘Primary care doctor’ plan will bring ‘demise’ of GP profession, says GPC chair

‘Primary care doctor’ plan will bring ‘demise’ of GP profession, says GPC chair

NHS England’s plans for non-GP ‘primary care doctors’ to be allowed to work in practices are ‘colluding in the demise of the profession’, the BMA’s GP committee chair has said.

Dr Katie Bramall-Stainer said that the commissioner’s plans are likely to cause a more ‘toxic’ and ‘stressful’ debate than the one about physician associates.

According to the GPC chair, plans would allow a range of different ‘primary care doctors’ to work alongside GPs in practices, including:

  • Doctors finishing foundation training
  • Doctors out of programme for clinical experience
  • Internationally-qualified GPs
  • International doctors who are not qualified GPs
  • Doctors who have failed MRCGP
  • Specialty and Associate Specialist (SAS) doctors
  • Consultant doctors

Speaking at an online roadshow last week, she added that NHS England is ‘putting pilots in place’ for a wide range of potential qualified and unqualified cohorts to work in GP practices across the country and that these are ‘colluding in the demise of the profession’.

Dr Bramall-Stainer said: ‘Primary care doctors are the name from NHS England, for any doctor who can now practice in a GP setting.

‘You know how there’s always been the performers list and how you had to be a GP to work in general practice. It’s gone now. You can be a consultant, you can be a staff grade doctor, you can be someone who’s just finished their foundation training.

‘But the point about primary care doctors is that if you think the physician associate debate has been toxic and hurtful and stressful for you, as a GP, witnessing what you’ve witnessed – it’s child’s play, compared to the primary care doctors’ debate, and that’s happening now and it’s starting now and NHS England are putting pilots in place.’

Dr Bramall-Stainer added: ‘If you come across them, feed back to your LMC. If you collude in garnering more evidence for NHSE then you are colluding in the demise of your profession.

‘They have disinvested 52% from GMS comparing 2022/23 with 2007/08. There is far more data in GP settings than trusts, our contracts are scrutinised so much more than trusts.

‘The only thing ICBs and NHSE care about is them hitting financial balance – by whatever means it takes – no matter how much workload is dumped on you.’

NHS England told Pulse that it has already spoken about this area of work as mentioned in the recovery plan last year but said it is ‘not running any national pilots’.

An NHS spokesperson said: ‘NHS England is not running any national pilots and under regulatory changes during COVID, doctors already working within an approved governance structure could also work in primary care.

‘All doctors are expected to work in accordance with the GMC’s Good Medical Practice, regardless of the setting.’

As announced in the recovery plan in June last year, the Government and NHS England will work together to ‘ensure that doctors other than GPs are more easily able to work in primary care’.

According to the plan, the medical workforce ‘is expected to change over the next 15 years’, with more SAS doctors and doctors in training choosing different career paths including general practice.

Ensuring that doctors other than GPs can work easily in primary care will give general practice additional capacity, improving patient access and creating opportunities for these doctors to develop and progress in their careers, the plan said. 

But the idea has proved controversial, with the BMA saying that the proposal could cause doctors to be open to exploitation under a ‘two-tier system’.

And LMC leaders called on the BMA to reject proposals which would allow SAS doctors to work in general practice as primary care doctors.

Note: This article was updated at 10.45 on 8 July to reflect that Dr Bramall-Stainer was not concerned solely about SAS doctors entering general practice.


          

READERS' COMMENTS [20]

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

Simmering Frog 3 July, 2024 3:57 pm

My concern here is the unfair playing field where only hospital trust run practices can employ these doctors in Primary Care.

So the bird flew away 3 July, 2024 4:18 pm

Don’t get why BMA getting worked up about this plan, while it took them ages to see the threat from unregulated PAs, and have been blind to all the other crap this Govt have been pouring on GPs’ heads for years. General practice needs more GPs. SAS are doctors, as PAs are noctors.
In fact all GPs were hospital doctors prior to their GP training and conversion. So why not take on SAS doctors (many of them IMG) into general practice, giving them a period of GP training to understand the special and peculiar aspects of how we work, manage everything coming through the door, learn to manage and live with uncertainty, and boost GP numbers plus funding. Better than the other fragmenting NHSE ideas that have been reported on over the last year.
Am I missing something about why the GPC is up in arms about this “issue”?

Larry LameLamb 3 July, 2024 5:49 pm

Yes ‘so the bird flew away’ you are missing something. PA’s, SAS Drs – with all this we’re basically getting rid of “specialist” GPs. MRCGP? Whats the point in that? RCGP? Really why do we need a Royal College for General Practice? What is General Practice. Its nothing. Its just a mess outside of hospital. Anyone with half a brain can work there. There will shortly be no such thing as a GP. There will be something called Primary Care and some people who work there. Divide and rule. The GP is dead. Thats what all this means. Thats what your missing. You don’t need to train to be a GP. Its easy. Ask any consultant surgeon. This is that prat Prof M Thomas..remember him? This is it..here. Blink and you’ll miss it. Gone

Samir Shah 3 July, 2024 5:49 pm

The idea is that it becomes a 2 tier service. Why not retrain those SAS doctors who are interested in General practice on a suitably shortened GP training scheme? Then they are GPs.
The NHS scheme creates a tiered service at best, and at worst says to the population that they don’t need highly trained professionals to create order from chaos, like Copperfield said, we is blatantly not true.

Larry LameLamb 3 July, 2024 6:02 pm

https://www.dailymail.co.uk/debate/article-2840252/Why-fear-GPs-NHS-s-problem-not-solution-surgeon-J-MEIRION-THOMAS.html

https://www.pulsetoday.co.uk/views/uncategorised/i-cannot-sit-back-and-watch-an-attack-on-our-profession/

It was 2014 – and now this guys vision has been enacted 10 years later. Do you remember the outcry it created? Well here it is in the flesh in 2024
The end of GPs ..the tertiary surgeons will be pleased with themselves

Reply moderated
Yes Man 3 July, 2024 6:15 pm

The very slow assassination of general practice is speeding up. Remember Mr penance the @unt?

Just My Opinion 3 July, 2024 7:17 pm

At least they are actual doctors rather than ARRS/PA nonsense.

J Smith 3 July, 2024 7:44 pm

unfair playing field, why would some one do GP training, pass a difficult CSA examination, when someone can do the job without these. or could it be GP also doing SAS job in cardiology neurology outpatient with crown indemnity protection?

paul cundy 3 July, 2024 11:22 pm

Dear All,
Well isn’t it a two way street for professionals? Lets all GPs register for posts as part time neurosurgeons. I’m certain I could have influenced a few of the cerebra of those who consuletd me if I’d actually been able to dice and dissect their actual grey matter.
Regards
Paul C

Pam Ama 4 July, 2024 6:19 am

So what’s the point in GP training? Being a GP is significantly different to being a hospital doctor that only sees their niche specialty. We see significantly large and wide number of cases, we know what to look it for in all aspects of medicine and clinical presentations, ruling out what not to send to secondary care and what to, knowing everything from minor cases to more serious cases, complex cases, managing patients in 10 minutes is no joke an takes skill that these hospitals will have to be trained up to do. GPs should be called primary care consultants and if SAS or other doctors that come into primary care then give them a different title entirely and different pay. Will they also take away all our admin burden ?! Or who’ll that be extra work dumped on us?!

Robert Caudwell 4 July, 2024 8:39 am

There’s already a way to become a GP and work in general practice, it’s called GP training. If I decided I fancied being a consultant surgeon I wouldn’t expect to apply for a job and do a bit of training under some harebrained scheme dreampt up by NHSE, so why would anyone think it’s appropriate the other way round?

So the bird flew away 4 July, 2024 9:49 am

@larry.lamelamb, thanks for responding. I get your irony and passion. Like you, I also think that GP is (almost) dead, but not because of this SAS scheme potentially in the future, but because of 14 years of Tory’s neoliberal approach to the public sector and their misrule destroying the NHS by austerity paid for by cuts to the public sector, underfunding, and fragmenting care into parcels ready for USA corporate interests as part of a future trade deal. Being against PAs and then being against other Drs (SAS) becoming GPs while moaning that there’s not enough GPs is not a good luck and won’t go down well with the public.
I don’t think being a GP is easy – for my 27 years in it (after 7 years mucking about in hospital), it’s special and a privilege to have worked with people and all the presentations of the human condition.
Hopefully the next Govt will get a grace period to show they mean to fund and build back general practice and veer back to a Keynesian understanding of a properly funded NHS and public sector, and steer away from the creeping privatisation of the neoliberal fundamentalists. Good luck.

A B 4 July, 2024 1:34 pm

Thankyou “so the bird flew away” I think what is needed is to step back a little and take a wide view. I suspect we are fundamentally on the same page. I’m not against the existence of SAS Drs or PAs the issue is there are not a replacement for GPs. All this effort in bringing in SAS Drs and PAs because there are no GPs..Fix the no GPs problem. We dont need SAS Drs and PAs WE NEED GPs. This isnt about being anti SAS Dr or PA is about keeping hold of a GP service. This is a trap. We need to fix tue reason why we cant get GPs not give up on GPs entirely and make a service where there aren’t any. This is the point.

A B 4 July, 2024 1:35 pm

AB was Larry LameLamb (but the name was lame)

So the bird flew away 4 July, 2024 2:53 pm

AB I agree with you that “we need GPs” but I would qualify it with “NOW”. Trouble is it takes 9 years to get a fully trained GP and the NHS/primary care can’t wait that long if it is to survive.
But if the next Govt, say Labour, go with this scheme, and they put SAS Drs through a GP training programme, and then get them working in GP practices, salaried, supporting independent GP contractors, then we have some immediate benefits.
You can see this as a trap or as an opportunity. But if properly funded and structured, this could rescue the independent contractor model.
By the way, imo, a GP is not born out of a paper qualification of VTS training, but made by the years/decades of the experience of grafting in the job.

Lochend Lad 4 July, 2024 3:29 pm

Completely agree with STBFA, using SAS is a pragmatic solution and far better than PAs. And maybe the balance between practical experience and educationist theory in VTS should be revisited?

Dave Haddock 4 July, 2024 4:09 pm

Losing the RCGP sounds good.
Wrong on everything to date.

A B 4 July, 2024 5:41 pm

There are plenty of GPs ..many of them are unemployed and/or under employed – NOW, TODAY, READING THIS. You don’t need to train a whole bunch of other people who will all find the role equally impossible..you need to fix the role, to address the problems causing so many GPs to leave and why its virtually impossible to work full time anymore. Getting other people in is the wrong solution and plays to a faulty narrative – namely there is something wrong with todays GPs. There is nothing wrong with todays GPs..its the JOB that needs fixing. All you folk arguing the solution is simply to employ people who have a different title are suffering from a “wood for the trees” phenomenon. They’re all just people, just people with less training. Its the job that needs fixing not the title of the person doing it. Step back..take a look around..this isn’t pragmatism, its just short sighted and naïve

Katie Bramall 5 July, 2024 6:11 pm

Pulse have got this wrong, sorry. Primary Care Doctors are not SAS doctors.

And there are pilots trying to be embedded so NHSE are not telling the full story here. We have been made aware of pilots in Humberside, Kent & Medway, North Norfolk and Wolverhampton.

Primary Care Doctors *are not SAS*
Don’t equate them to SAS Drs. SAS Drs are valued associate specialist colleagues.
PCDrs will be a variety of cohorts:

1 Drs finishing foundation training
2 Drs looking for OOPE
3 International qualified GPs
4 International doctors who are not qualified GPs
5 Drs who’ve failed MRCGP
6 SAS Drs
7 Consultant Drs

The point I’ve made is the toxicity of drs divided against drs & many will relish this, including the pro-PA agenda.

There is a route to GP & it’s a VTS.
There’s a route to Dr & it’s MBBS/MB ChB.

Imran Sharieff 5 July, 2024 10:46 pm

Dear Editor,

Anna Colivicchi’s article quotes Dr. Katie Bramall-Stainer referring to SAS doctors as “staff grades,” a term that is not only outdated but also offensive. The correct umbrella term is SAS, which stands for Specialist, Associate Specialist, and Specialty Doctors. This language is particularly disappointing given that many SAS doctors, who often come from diverse ethnic backgrounds and have faced discrimination, are trying to move past the negative connotations of the “staff grade” label.

Dr. Bramall-Stainer’s comments equating the presence of SAS doctors in primary care with the “demise” of the GP profession are deeply alarming. Unlike physician associates, SAS doctors bring a wealth of experience and medical training, even if they are not on the GP specialist register. In a genuine workforce crisis, it is illogical and exclusionary to deny them the opportunity to contribute to primary care. If paramedics, nurse specialists, pharmacists, and physician associates can have roles in primary care, why are SAS doctors, the most diverse part of the medical workforce, being excluded?

The assertion that SAS doctors would undermine the role of GPs is unfounded. GPs will always be the gold standard in primary care. There are not huge numbers of secondary care SAS that want to work in primary care but there are doctors that, for one reason or another, do not complete formal GP training schemes or membership examinations. Instead of viewing SAS doctors as a threat, we should recognize their potential to alleviate the current workforce crisis and improve patient access to care.

Sincerely,

Imran Sharieff
SAS Anaesthetist
Lewisham and Greenwich NHS Trust
BMA SAS Committee