NHS England has recently announced that it will be looking at all payments for locum cover made to GP practices to provide for maternity, paternity and adoption leave, as well as sickness absence. The current system for these payments not only varies widely across the country, but being discretionary in nature, it is an unreliable and unpredictable source of income for practices.
Whilst concerns have been raised that such a review will lead to a levelling-down of current provision and worsening of the situation, an alternative argument exists – namely that general practice has not only failed to keep up with the changing make-up of its workforce, but has also failed to keep pace with changing social attitudes to work life balance and expectations regarding access to health care.
The traditional partnership model is based on two or more GPs committing to provide general practice to a registered population. Whilst since the contract changes in 2004 there has been an increase in salaried posts (in 2008 20% of GPs were in salaried roles) and an increase in portfolio careers, partnership continues to be the main choice for GPs in 2013.
Time to update
This model has served us well for over 60 years – it comes with it huge freedoms in how we organise our practices, how we work, and who we employ, whilst at the same time providing us with a good income and a pension that many outside of medicine perceive to be generous. Leaving the pensions issue to one side, why would we wish to alter the status quo?
Society has changed. No longer do we live in a world where the man is the breadwinner, with a wife and/or housekeeper at home.
Nor does our society now have shops that close at 12pm on Saturday, where it is not possible to buy a bottle of wine on a Sunday afternoon or get cash out of the bank at the weekend. We no longer live in a society where calling the GP at 3am in morning is due to an emergency – it’s more likely to be a query that could reasonably wait until the next routine appointment.
We live in a society that works longer hours, has expectations of a service being available when we want it and which questions what is provided and how. In short, we live in a society that drives GP partners to work 12-14 hour days and still be deemed to be providing an inadequate service.
Better for all GPs
This is not just an issue for women (although with approximately 60% of medical students being female and 47% of doctors on the GP register being women, the feminisation of the GP workforce is a significant driver), it is of interest to the whole family and the profession. Ten per cent of stay-at-home parents are now fathers and fathers wish to be available to attend school and social events with and for their families. Recently, my practice hosted a male medical student who was most concerned about how he could be an involved father if he continues to work within medicine.
This does not mean we have to move towards a totally salaried service – although that is one option. It means acknowledging that we need flexible working, part time working, team working, smaller registered lists and an increased acceptance of skill mix in order to evolve our profession.
By engaging with the review, we can allow the profession to drive the future of general practice rather than reacting to another wave of impositions.
Dr Helen Cotton is a GP in Yeovil and PMS lead of Somerset LMC.