Once considered unassailable, the independent contractor status of GPs is being undermined like never before.
In the most significant intervention to date, the man who could be the next health secretary has suggested that general practice should move towards becoming a largely salaried profession.
It seems Andy Burnham has been bitten by the same Kaiser Permanente bug that has infected NHS England deputy medical director Dr Mike Bewick and former RCGP chair Professor Clare Gerada, raising the prospect of GPs working for an increasing number of large ‘integrated care organisations’.
But abandoning the model of general practice that has been in existence since the formation of the NHS would have wide repercussions.
Independent contractor status is the bedrock of general practice. It enables GPs to be effective advocates for their patients and ensures that they are able to speak out when they witness the NHS failing them.
It also means that general practice is an incredibly lean and efficient service. If the NHS had to pay overtime for all the evenings and weekends that partners work to keep up with the mountains of additional paperwork generated by their practices, then it would quickly bust its finances.
ICOs are likely to be run by foundation trusts employing GP practices as shop windows for their specialist services, meaning a greater shift towards expensive secondary care. They could also be easily packaged and sold off to private healthcare providers, with GPs becoming mere lackeys inside a corporate-run primary care service that is run for the benefit of shareholders and not patients.
And the signs are that Mr Burnham would face considerable opposition from GPs themselves. A recent Pulse survey showing that more than three-quarters of GPs are against ditching their independent status. The GPC has said that it will put off many from joining the general practice if they see that they will not have the same status as now.
But the push towards a salaried profession is not just from on high. As a reporter at Pulse a few years ago, I remember writing story after story about the ‘salaried-partner divide’ and how the partnership shortage was denying young GPs the chance to progress. How times have changed.
Practices across the country are struggling to recruit partners. The next generation of GPs are plumping for salaried or locum positions that offer the freedom to spend time with their families and have time outside the surgery. There is something to be said for the benefits of salaried employment – maternity and paternity pay, sick leave, employment rights. Why take on a stressful partnership that (in some cases) pays less than a salaried position?
So while Mr Burnham may have settled on this idea for his own reasons, don’t be surprised if it catches on. The days of the GP partnership may be numbered.