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Hoodwinking the profession

Hoodwinking the profession

You may have missed it, but two months ago we were blessed with a document from the Policy Exchange think-tank that proposed to reform general practice. Like many of its ilk, it proposed to do this through the usual political buzzwords: digital healthcare, working at scale and a multidisciplinary workforce. 

But what made this particular document more egregious than the many others was the explicit narrative about the contractual status of GPs in the future – that the vast majority of us should be salaried to at-scale providers, who may or may not be GP partners. This would be enabled through the phasing out of the GMS contract by the end of the decade, and an offer of generous employment terms and conditions for existing GP partners. 

What I find oxymoronic about this vision is that it was implicitly endorsed by a Conservative Government in the form of a foreword from the health secretary Sajid Javid. The bastion of small business ownership and commercial enterprise suddenly wants to become Robin Hood when it comes to general practice. They want to stop those fat-cat GP partners amassing wealth through the plundering of their salaried colleagues. Yet their driver is not based on the principles of social ownership or wealth equity. Instead, it is rooted in the misguided belief that this reform will ultimately result in less healthcare spend in general practice. 

I challenge anyone who has never been a GP partner to truly understand the all-consuming emotional, operational and financial impacts of the role. As with any other small business, the buck stops with you when the toilet is blocked, or when staff are off sick. The latter has been an increasing issue – Covid-related sickness means GP partners are cancelling their leave because of workforce shortages. 

So when a figure of around £105,000 per year gets thrown around to represent average annual income for GP partners, it doesn’t take account of the number of hours spent earning this, the additional work on days off and weekends, and the mental stress of feeling married to your job. Above all, it does not truly represent the enormous responsibility of serving your population, and the innovation and creativity this requires. When considered in this way, GP partners offer remarkable value for money at an almost exploitative hourly rate. 

Some people will be seduced by the headlines of the financial package for the ‘future GP’. This includes a salary equivalent to a consultant, plus additional clinical excellence awards for teaching or leadership, resulting in a salary of more than £120,000 for experienced GPs working a 40-hour week, with protected time for administration and CPD. What’s not to like?

Well, if something seems too good to be true, it probably is. If current salaried GPs think that the Government will ride through Sherwood Forest and double their income in return for dissolving the partnership model, they need to think again. As with the GP out-of-hours contract, as soon as it becomes apparent how utterly efficient the independent contractor model is, core general practice will be staffed by an army of less expensive professionals and only a handful of GP generals for supervision. 

Be in no doubt that the end of the independent contractor model will mark the end of general practice as we know it. 

Dr Shaba Nabi is a GP trainer in Bristol.

Read more Dr Nabi’s blogs here



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

Patrufini Duffy 16 May, 2022 4:33 pm

The public, nor most MPs, do not realise who pays for your toilet roll, printer ink and couch roll and that odd speculum and otoscope tip dashed. The black pens the public “borrow” and the Toilet Duck for the soiling incurred and paper for printing their normal results. Most of this lot are paying monthly more for their booze trips, gym and phone contracts than you. And they want a drinks machine one FFT said – sure, with prosecco and blue cheese. Nor do half the locums and salary workforce realise the reality of General Practice tbh. Therein lies a major issue.

David Church 17 May, 2022 10:31 am

£ 105,000 !
That’s rather less than £ 30 per hour.
An experienced GP Partner should not be valued less than a Consultant – I think start about £ 50 per hour at the very least.
Oh dear, Parliament can;t afford that because they need the money for the bars at Westminster.

Vinci Ho 17 May, 2022 10:18 pm

I think there is a political reality we need to recognise here :
(1) This government has made up their mind to end independent status of GPs , which is something GPs of my generation (age 57 this year ) has been talking about this inevitable last 10 years
(2) At the end of the day , it is still about terms and conditions of whatever this next GP contract will become . Speculation remains speculation. Nothing is black and white until officially signed . Of course , it is about whoever representing us will get something ‘sensible’ on the negotiating table . Arguably , we should be awarded as consultants in primary care .
And I am conscious that many GP colleagues ( partners or salaried ones) are sceptical about the political abilities of BMA/GPC with all kinds of contentious issues going inside its establishment. But whoever or whichever are to represent all GPs in this historic moment , it is only a fine line between negotiation and extortion facing up against our enemy. We need some Wise Mind ( a balance between the two types of mindfulness: Reasonable Mind and Emotional Mind; learnings in my current therapy 😳😎)with some luck .
(3) From the point of protecting colleagues, I think we need to understand especially our young colleagues need an opportunity to see some prospects of a future that they can take for their next 20 years of life . Youth is NOT wasted on the young( never agree with Mr Shaw on his famous saying ). I wish I had the magic power to ensure that is to happen for all of them ……..
At the moment , I am just an old witness of history at a defining moment ……

Simon Read 21 May, 2022 1:32 pm

i fully agree with your comments. i think many or most people running a small business and being an employer will understand the all consuming nature of it. but in addition to that those of us with GMS contracts hold unlimited liability, which for most business is not typical. and that is a very real and present additional stress at times, particularly as the political tide seems to be moving onwards with an agenda of ending the independent contractor statues.

Steven Hopkins 22 May, 2022 12:17 pm

For goodness sake stop bleating about everything. It demeans our profession and just makes us complainers who have no solution to the manifold problems of the NHS than, “give us more money”.
If anybody thinks they are worth £50 per hour, then go private and test the waters. But, in the meantime, stop complaining and do something to rectify the situation. If you can’t, then why blame politicians for having as little imagination and business acumen than you do.

Syed Mehdi 24 May, 2022 9:17 am

Just mention partner, money and you get a “reaction”, nobody just “serves”, everyone “earns”, and partners do know how! And they also know how to “use” Locum and salaried GPs and indeed registerars, the pandemic is still going on for most of them, doing telephone and admin, rest by salaried GPs, registrars, paramedics, nurses, LOL. And don’t tell me it’s not so ! Let’s all suffer!

Syed Mehdi 24 May, 2022 9:19 am

@Steve Hopkins, you must be pretty “GOOD”!😂

The Prime Minister 24 May, 2022 2:54 pm

SteveHopkins…another Daily Nutter journalist…..True the attitude is if we don’t like it the f*** o**….thing is we are all happy to F off and are currently doing so so don’t start bleating that you can’t get an appointment because we don’t want to hear this tiresome moaning-the situation is either pay up or F off.

The Prime Minister 24 May, 2022 5:09 pm

Why can’t PULSE kick out journalists?

Impersonating GPs yet revealing such an ignorance of the system…..test the waters….what crap….locums earn £75-£100 per hour but being a GP (not) you would know that….impersonating GPs demeans other journalists so show your colleagues some respect

Decorum Est 25 May, 2022 1:47 am

Steven Hopkins 22 May, 2022 12:17 pm
For goodness sake stop bleating about everything. It demeans our profession and just makes us complainers who have no solution to the manifold problems of the NHS than, “give us more money”.
If anybody thinks they are worth £50 per hour,

Recently had a painter ‘quite unreliable’ charge £50 per hour.
And a ‘highly trained and highly regulated professional’ is worth less?

North London GP 7 September, 2022 10:37 am

Locum GP rates seem to have increased in London which is not surprising given inflation. These are currently in the £110 to 150 per hour mark so I don’t think any GP should thinking about £50 per hour as an equivalent salary target. The bottom line is that terms and conditions (including pay) will need to be better in substantive posts. Otherwise we will choose a large proportion of new and experienced GPs to the locum option or retirement. This will only make patient access and working conditions for those in permanent conditions worse.