Our Building a Better General Practice campaign has been a fascinating exercise. We have had a range of voices from across the spectrum of general practice. Some are well-known names and others aren’t – but they have all thought deeply about the essence of general practice.
Last week’s panel meeting was perhaps the most interesting as we spoke about how GPs should be contracted – in a nutshell, the salaried or partnership debate.
You might feel this has been done to death, but there was real nuance in this debate. The central point became – if you were designing general practice from scratch, would you want it to be arranged as autonomous small businesses?
The consensus of the panel was that the partnership model worked in the past, before we had a mixed workforce (salaried and partners) and micromanagement from ministers and NHS managers. But now, we have the worst of all worlds – partners tied to a contract that is so prescriptive as to make them almost salaried, but having to take on all the bureaucracy associated with running a normal business.
So when we made our survey live, I was expecting our readers to reject the idea of general practice comprising small businesses. But I was wrong. There was a complete split on the question of whether the current partnership model is obsolete – an average score of 2.5 out of 5. But when it came to the more general statements of general practice as being comprised of autonomous businesses, there was more agreement – 4.02 for the question ‘is it possible to work in autonomous businesses and provide adequate clinical care?’
Perhaps most surprisingly, then analysing based on age, the younger generations were in fact a little more in favour of a partnership-style model than the older ones.
So what can we take from this? GPs are not in favour of moving to a similar model as hospitals, run by the NHS and managers, even if headed by a medical director. Yet there has to be a change – again, overwhelmingly, GPs say that running a business shouldn’t take any time away from clinical care.
It is not easy. But squaring this circle is essential if we are going to get general practice out of the crisis it is in. And, unfortunately, I have little faith in ministers supporting GPs in this. So it remains up to the profession to put forward a positive case in terms of how general practice should be run. So please continue contributing to our surveys, and sending your thoughts to firstname.lastname@example.org as you have been doing. Because GPs really do know best when it comes to general practice.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at email@example.com.