The announcement that NHS England expect to harvest practice-level locum data came as no real surprise. The Government has already revealed how terrified they are of the market rate through the introduction of fee caps for junior doctors which are, quite frankly, insulting, and deserve all of the unintended consequences that they will reap.
If there are no permanent GPs to cover there will be no locum work worth having
The threat is formless on the horizon, but the intended outcome obvious to all: a pliant workforce, managed, rostered, salaried; working cheek-by-jowl in shifts with cheery phys assistants, their Fisher Price stethoscope nestled proudly on their shoulders. They want to smoke you all out and impose limits on your current bounty of choice; yoked and shackled and dependent on the employer.
There really is only one way to resist this, and that’s by shoring the defences. Of my training group (Salford, Class of 2013), only two of 20 or so of us have chosen to saddle ourselves with partnership. My colleagues – excellent, tenacious GPs – have mostly headed into sessional work. That, of course, is the most sensible decision. They are contented and free range, strutting proudly into the sun whilst we toil in the caves of bureaucracy below. They probably laugh at me behind my back, calling me names, decrying my gross stupidity.
But the truth is that it really isn’t that bad. It really isn’t! I still have control over my working life, more in fact, and there is great satisfaction to be gained from helping to shape a practice in your own image, from the responsibility of ownership, from the acquisition of skills I never thought I’d need or have.
I would understand if it really were a world of haves and have-nots out there, of fat-cat partners wolfing cheese and port in their ivory towers and hoisting up the drawbridge behind them. But there are good practices up and down the land desperate for fresh blood and good ideas. Knowledge dissipates into the ether as venerable old pros retire with nobody to take their place. Similarly, there are great GP leaders out there who aren’t giving themselves the opportunity to lead.
The fewer empty seats that are filled – the more practices that go to the wire – the more vulnerable we all are.
The vultures are cocking their heads. If we don’t support the independent contractor model, then we inadvertently serve it trussed up for consumption by the local (un)friendly, aggressively acquisitive super trust. We work for their laughable internal rates. We kiss goodbye to clinical and professional independence and submit ourselves to the whims of adminiodroids, who just needs you to cover that plum twilight shift before they can clock off at 20 to four, goshdarnit. We agree to non-clinical management, infection control autocracy and the kind of unwelcome scrutiny which we all chose general practice to avoid.
We must be very, very careful what we wish for. If there are no permanent GPs to cover there will be no locum work worth having. So I beseech my First5 colleagues: scour the job adverts with an open mind. If there’s a practice you like, take the plunge. Because if enthusiastic young GPs don’t answer the call then we leave ourselves exposed as the bigger picture develops. Like our junior colleagues, we are stronger together. We need your help.
Dr Karim Adab is a GP in Manchester
