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.
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