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Independent’s alright



We have almost become immune to the constant berating by the press about how GP partners are all lazy, overpaid and clueless. But what we do not expect is for prominent GPs to jump on the bandwagon that GP principals have exceeded their sell by date.

Those who believe that the independent contractor status lies at the root of all the problems in primary care demonstrate at best naivety, and at worst, a hidden agenda. The cracks within general practice are a symptom and not a cause of the crisis that is facing the health service.

UK general practice, through the partnership model, is the most cost-effective delivery of primary care in the Western World because:

We are not paid for activity but through capitation. This means limitless (and often valueless) work can be piled on to us for no increase in income.

  1. We are some of the most skilled GPs in the world, looking after everything from severe mental illness, neonatology, pregnancy and patients with complex co-morbidities who were historically managed in secondary care.
  2. The increased demands and expectations of patients, fuelled by the choice agenda of successive governments, has not cost a penny of public money as it is all being sucked up by partnerships that have had very little investment in the last 10 years.

So why are politicians, the press and now senior GPs questioning the value of the independent contractor status? The answer is very simple.

We are at breaking point.

We have had enough of the bureaucracy, the tick boxes, the protocols, the patients’ demands and most of all, the lack of respect. So in a rather topsy turvy world, instead of addressing some of the issues that are causing this demoralisation, it is felt that the whole partnership model is flawed. Instead of questioning the effectiveness of partnership models, we should be demanding a massive investment into an area of healthcare delivery that has already saved the country millions of pounds.

Those who are happy to abdicate their management responsibilities and  become salaried staff, in return for set hours of work and decent terms and conditions, are deluded if they think things will improve. The country cannot afford us unless we go down a co-payment route and that is likely to be the hidden agenda; blaming GPs for the demise of the NHS.

As for me, I would rather work out the rest of my years, treating everyone equally, irrespective of their income. But I cannot do this without the support of the government and my leaders.

Don’t fix what ain’t broken…just nurture it a little more and you will continue to get the best primary care in the world.

You will not realise this until it’s gone.

Dr Shaba Nabi is a GP trainer in Bristol