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Practices are not businesses

Practices are not businesses

Whenever the issue of NHS privatisation is brought up, there is always someone who points out that, actually, GP practices are private businesses themselves.

I’ve thought a lot about this and for me, it’s a myth that needs to be put to bed. It is true that, as independent contractors, there is a measure of autonomy that purely public sector organisations don’t have.

But equally, is there any other private sector company that has a single contract with one organisation that they realistically have no (or hardly any) say in negotiating? And even the way they spend the money is often proscribed – think the additional roles reimbursement scheme, for example. GP practices are only nominally businesses.

What made me bring this up was the sad story of Central Lakes Medical Group. This is a practice that has struggled for a while due to its particular circumstances. Being in a touristy area, much of its work involved caring for out of towner. It’s not entirely clear why the global sum didn’t reward them enough for this work they were doing, but we know it didn’t. The CCG had agreed to provide atypical funding of £70,000 a year, which kept it afloat.

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However, this was dependent on commissioners continuing to provide this. But they didn’t. Commissioners made the decision to move the funding to a different service to cater for tourists, which doesn’t seem to have worked. And when the funding was removed, the practice became unviable. So even if the practice is replaced as the integrated care board says it will, patients will still be left without their popular GP practice.

This wasn’t poor business sense from the partners, or a failure to show flexibility. Any other ‘business’ would’ve either changed their business model or moved location. But, providing an essential service, CLMG didn’t have this option. It was reliant on the whim of a separate body. This doesn’t like a typical business to me.

I’m not (necessarily) advocating to ditch the independent contractor status model. But there is a change of mindset needed. There has to be an acknowledgement that – although there are a couple of bad apples – GP practices that ‘fail’ are very rarely to blame and are almost always a victim of circumstance.

A GP practice having to close is not like a restaurant going bankrupt (as sad as that is) – these practices need support from the state. And commissioners should think of that before pulling funding without a decent plan.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash  or email him at



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

Patrufini Duffy 12 August, 2022 3:38 pm

Let them close it all down Jaimie. The riots are coming. And doctors won’t be seen anywhere. The cover-up and instructional SOPs is over. The GP good-doers gone and disinterested from the soulless high-street and rural backyard. No one to talk and bludgeon anymore. Where will they all go? The millions per day. Where will they telephone? Who will they send the inert emails and tasks to? Who cares to even read it. Who wants to be monitored and tracked? People are currently dying and suffering in all formats and this country made it happen and are covering up truth. But others are waking up and can see the real disease of lies and ugly hierarchies. Made in Britain. We may act stupid enacting their game, but that doesn’t mean we are all stupid after the compulsory meeting. Say nothing, and trust no one. The GPs real oath. Their play on a carers nature, that old age tradition of psychological manipulation and guilt and narcissistic ploy and speciality, is plain obvious and comical – but stupid for them, once that care is burnt there is nothing left to burn…the toxic relationship is scarred. The abuse is done. Professional violence, institutional persecution, call it what you may. The fire is only left to consume itself. It is so ugly, not even I know who it comes from. They’re up there though. Private or not private, it is individual people putting their hands up to do societies dirty, forgotten and tainted work for the juggernaut machine. But, they don’t need to do that anymore. Because the machine has chains and it hurts. Like gasoline and energy, disrespecting carers will now backfire immensely for time immemorial, as the public start turning on the institutes. The workhorse is no longer there. The gatekeeper walked off. The world needed them elsewhere. And the new ones they brought in are not so tolerant. They break down easier and move on to brighter shores without compromise. The leaders are now exposed and they will feel the real heat of public offering day by day. Whistleblowers are ready in all sectors. The UK has a track history in corruption, dishonesty and advertising and marketing manipulation. But, the public, when they’re promised something they can’t get or can’t find, then die or experience pain, will not be so forgiving. They’re getting a little uneasy and irritated now. Football, drinks and media cover-up doesn’t do it anymore. It is all falling at their hands nicely.
Well done.
Front row seats are incredible.
Disintegration. Uncaring. Board-em.

Guy Wilkinson 12 August, 2022 3:38 pm

First time I find myself disagreeing with your editorial Jamie.

For GMS contract we have full flexibility of provision. I certainly regard my business as a private partnership. The only atypical areas of reimbursement are pensions and premises.

The least said about PCNs the better – the contract was clearly created to limit skill mix, training up and GP reward.

Sujoy Biswas 13 August, 2022 11:44 am

But we are businesses, We have to make a profit to survive, thats what makes us so irreplaceable — how else can you deliver a consult with a GP in a western country for 23 pounds a pop?

John Evans 22 August, 2022 4:58 pm

We cannot afford the number of GPs required to meet the demand that has been generated.
Why speculate on a brilliant new way to deliver. The choices are already in play.

US model 1. lesser skilled / cheaper gatekeepers 2. Many citizens left without comprehensive healthcare. However, any savings are simply consumed by the private companies overheads and profits. 3. The fortunate are over indulged. You then brain wash the population in to believing that anyone/everyone can succeed even though the facts are obvious. Very many won’t.

European model 1. Modest charges and other mechanisms to control demand 2. More clinicians working as clinicians although paid less.

USSR model – Central control with manipulation of data until the obvious failure cannot be hidden and the system collapses. Vultures circle and cherry pick the profitable bits from the ruins.

I think that the govt thought they knew best and aimed for the US model. Bizarrely even the “taster” when out of hours services were outsourced (hugely more expensive) they did not lose faith.. However, UK is financially compromised and we are following the USSR model. Indeed, the pension tax charges (especially during a time of high inflation) will scare off more GPs than they can recruit and the system will fail to meet public expectations in the most obvious ways.

The crashed economy will reduce your income either through massively sub-inflation pay rises or through spurious tax thresholds that will keep your income suppressed. I would suggest looking at the European systems and working to a more sustainable work like balance that may be more consistent with a lower income.

I would strongly advise Drs over 50 to check that the inflationary increases do not tip you over LTA. This is especially important for those already opted out of the NHS pension as the inflationary increases may only be reflected in your fund at the time of collecting (you could have a very nasty surprise).

Best of luck.