The independent contractor model has been at the core of UK general practice since the NHS was established. A strong primary care sector has allowed the NHS to operate efficiently – GP practices have typically used between 8% and 10% of the total NHS budget and dealt with up to 90% of all patient contacts.
However, many GPs now find themselves struggling to cope. This makes it difficult for patients to see GPs. We are also now seeing a divide between salaried GPs and GP partners.
We have seen the RCGP and the BMA lobby for increased support for general practice with little success. To ensure general practice remains an attractive and rewarding career option, and that primary care remains the foundation of the NHS, we now need a serious debate about funding and employment models.
We need to consider more radical options, such as a salaried GP service in which all GPs are employed by the NHS.
A salaried service could allow GPs to be employed on similar terms to NHS consultants, with a salary based on experience and with additional payments for management or clinical leadership. GPs could also then have job plans, as consultants do, with sufficient time for administrative work and teaching.
Another benefit of a salaried service would be better workforce planning for local needs. GPs could be employed by the same organisations as specialists, giving greater opportunities for integrated working with secondary care.
Giving up independent status would be a huge step and one that many would find difficult. GPs benefit from the political clout and freedom to operate as we wish. But if we don’t start to negotiate on our employment terms, the likely alternative is a proliferation of APMS contracts and, increasingly, employment by commercial companies on worse terms than the NHS.
Professor Azeem Majeed is head of the department of primary care at Imperial College London and a GP partner in Clapham, south London