‘GPs nationalised in Javid plan to reduce hospital admissions,’ The Times declared in late January. The reality was a little less dramatic – but only a little. The report stated that health secretary Sajid Javid was looking towards some GPs being employed under trusts in England (even if his speech yesterday didn’t clarify this further).
At the same time, the BMA GP Committee chair Dr Farah Jameel has called for a new English GP contract that is ‘fit for purpose’ for GPs and patients.
Most parties – including the Government, the NHS and GPs themselves – recognise that general practice must change. Ahead of the next contract in 2024, we may see and hear many radical solutions.
But I don’t see any consensus among GPs about what these radical solutions should be. Of course, all GPs want to see the end of CQC inspections, the overblown revalidation and appraisal process, diktats from ministers and NHS England on face-to-face and remote consultations and workload dump from hospitals. There is some agreement around the removal – or at least revamping – of the QOF, and an overhaul of the PCN DES. But let’s face it, even if all that was done, the effect would be negligible as long as patient demand grows and GP numbers stagnate.
So what could improve the working lives of GPs? This may sound like sacrilege, but I see some merit in offering GP partners the option to give up their contract and become salaried. This would include an offer to buy the property of partners who own their premises, but also to take over the responsibility for inspections, standards, waiting times etc, so they could focus on patient care.
This obviously begs the question of who the employer would be. This is where it gets trickier. The current frontrunners seem to be hospital trusts. And maybe this could work.
There are numerous caveats: most importantly, GP partners must have the option to continue as they are. And for those who do work under a trust, a GP must remain medical director of the practice (or, dare I say, department?) with a guaranteed place on the board.
But there are also benefits. Most of all, GPs would have set working hours, they could concentrate on patient care and see bureaucracy greatly reduced. It might even lead to proper integration, with the trust management deciding against burdening their GPs with a workload dump that would be better done elsewhere or by more junior staff (maybe even, you know, organising blood tests).
It would also be more attractive to younger GPs who, as I’ve argued before, aren’t as interested in partnerships due to (perfectly understandable) generational differences – as shown by partner numbers declining faster than the overall GP workforce.
I’m not kidding myself – this is nowhere near an ideal approach. There will be cultural issues, and a danger of GPs having to take on non-primary care work when the trust needs it. And it is not as though secondary care is in a great state itself – or that hospital doctors have a great work-life balance – so there may be a bit of frying pan and fire here.
Maybe I’ve fallen for the Government’s trick of damaging general practice so much that GPs will accept anything. And maybe this is a dreadful idea. As one of the below-the-line commenters said on our cover feature, even if it might benefit GPs, it might not be good for patients or good value for money.
But I feel it is incumbent upon the profession to think about radical solutions, and to come up with its own. Without that, we’ll see – at best – fiddling around the edges and at worst, radical ideas from the wrong people.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at firstname.lastname@example.org. This is the full version of the editorial that appeared in the March issue of the print issue