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Opening the door to privatisation

The classifieds are full of them: advertisements for salaried GPs.

Fifteen years ago, salaried positions were uncommon. Treading the career path from apprentice to GP partner there may have been locum jobs, retainerships or fellowships. And there were some people – mainly women – who worked as GP assistants, part time, without wanting to become partners at all.

But the politics of our jobs have now changed. I am reading through job descriptions where salaried doctors are expected to take on the role of ‘lead’ for QOF work in an otherwise nurse-led practice. Then there are salaried jobs with ‘a view’ to partnership, and PCT-run practices where all the doctors are salaried.

GP partnership profits are now falling, and the push from private companies tendering for primary care services is forcing an inherent instability into the NHS.

The small business model of general practice, which in the past has represented efficiency, community and service, is now seen as rich pickings to profit from – while at the same time the media makes it out to be a greed-driven model that overpaid doctors can make too much from.

This change is on our watch. And every single GP job that becomes salaried makes it easier for the private sector to sneak in and snap it up.

Sharing the load

I understand that it has not always been better to be a partner than salaried; for a long time, salaried GPs may have been paid more for less hassle with paperwork and management. I also understand that, for GPs working in unstable conditions, taking on a short-term salaried doctor rather than replacing a partner like for like might seem more prudent.

But I also know that there are many young, enthusiastic, passionate GPs out there who desperately want partnerships and are not seeing any advertised.

They know that salaried jobs can disappear, or that a management structure can emerge which cares only for points and targets. Partners too should surely know that the more salaried posts there are out there, the easier it becomes for private companies to move in and take over.

Is this really the kind of legacy we want to leave after our turn ‘safekeeping’  the NHS? The good ship is in danger of sinking.

Partnerships can be stressful and the responsibilities onerous. But the best way to reduce this load is not to hand it to private companies  to deal with, but to share it around – with our colleagues as our professional partners.

Dr Margaret McCartney is a GP in Glasgow