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We need radical solutions, but do we want them?

GMC Arora

‘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 This is the full version of the editorial that appeared in the March issue of the print issue


David Church 11 March, 2022 1:04 pm

You are absolutely right. There are massive potential benefits to GPs, and to patients. But there are also massive potential pitfalls.
Some of the pitfalls are the same ones as in 1948 – particularly loss of freedom and autonomy to refer a patient anywhere – although this ‘right to choice’ of the patient has been significantly eroded despite loud lip-service to it for over 2 decades.
There must be guarantee of no undue pressure from employing Trusts to unduly influence business to come to their hospital, regardless of care quality and patient choice – and there must be proper support to the GPs to be enabled to raise isues of care quality without being subject to the unfair and bullying hospital disciplinary service currently being widely used to punish whistleblowers – even when they do so because of a GMC-imposed duty to blow a whistle publically on corrupt and inappropriate practices in hospitals and unsafe care.
The other danger, is of course that the independent Contractor model is exceedingly good value for money to the NHS, and properly run and fully serviced Health Board ‘Managed’ Practices cost an awful lot more to staff and run than an IC GP service.
But if GPs can find their solidarity gene, it could be made to work very well for all.

David jenkins 12 March, 2022 7:05 pm

the cost to run an independent practice in south wales is approx £50-65/patient. the cost for the (mis)managed practices is over £150/patient per year.

David jenkins 12 March, 2022 7:07 pm

oh – and the work doesn’t get done !
there is a boxful of firearms/dvla paperwork in one of the patches i work in !

Andrew Jackson 13 March, 2022 11:28 am

Young GPs committing their futures to General Practice haven’t been asked their views on this.
The decision is being made by PCN decision makers i.e. Partners and those avoiding seeing patients by being leaders.
It is wrong and the BMA needs to hear all voices.

Simon Macartney 13 March, 2022 11:45 am

Please do not debate the nonsense Javid is spouting
It has not been costed, analysed , debated , planned or even thought through
He is the most toxic health secretary we have had in a very long time and to give him any credence will be the downfall of us all
For all our sakes, treat it with the derision it should inspire in you as a paid journalist or go and join the daily mail where I’m sure they are having a lovely time hearing this nonsense