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Should general practice give up the independent contractor status and partnership model

Institute for Public Policy Research (IPPR) Report

All new GPs should be offered salaried employment as ‘primary care consultants,’ suggests a new think tank report.

GP practices should also operate as ‘spokes’ to a central ‘neighbourhood health hub,’ according to the Institute for Public Policy Research (IPPR). Its new report proposes a 10-point plan reforming health and care services to shift towards prevention and productivity. Currently, services are ‘failing’ to make the country healthier and more prosperous, and on the current trajectory, the UK will increasingly ‘spend more to get less,’ according to the think tank.

William Greenwood
William Greenwood

The authors argued that reforming primary and community care should be at the centre of any shift towards a preventative service, away from a ‘treatment’ service. While primary care was once considered the ‘jewel in the crown’ of the NHS, the report said it has now ‘become a focal point for public dissatisfaction.’

The action plan recognised the need to balance continuity of GP care, which is associated with lower mortality rates, with the ability to scale up primary care so that various community services can be integrated. It said: ‘We propose an evolution in the PCN model. We recommend the “network” model is developed into a “hub and spoke” model, with a central Neighbourhood Health Hub created at the centre of every PCN.’

The proposed hubs would join up services such as mental healthcare and outpatient diagnostics, as well as take responsibility from GP practices for population health management and enhanced service provision, while practices, as spokes, can continue to focus on delivering continuity to patients. The report said that GP partners’ time would remain ‘constrained’ by the administration and stress of running a partnership. As such, another action in the 10-point plan urged the Government to ensure all newly qualified GPs have a right to salaried employment, with pay in line with hospital consultants.

According to the authors, this should also be offered to GP partners over time, with ICSs offering to purchase any GP practice where partners take it up. However, they emphasised that ‘no partner should be forced to accept these salaried roles. This would make a general practice career more ‘attractive’ and ‘sustainable’ by cutting bureaucracy and enabling portfolio roles with more variety.

The report said: ‘The alternative is to allow the partnership model to decline at pace. This would risk heaping a significant administrative burden on an increasingly small number of overworked, partner GPs. ‘Worse, it could lead to partner GPs struggling to get out of their contracts and practices at retirement. This is not a viable vision for an area of healthcare as integral to the future as primary care.’ The think tank has put forward these plans before the pandemic, and in June, Lord Ara Darzi, chair of the IPPR’s Commission on Health and Prosperity, argued that GP services should be brought ‘into the fold’.

More widely, the report lays out the case for reforming healthcare, drawing on modelling showing that 240,000 fewer people would have died in the decade from 2010 if the UK had an avoidable mortality rate like those in comparable European countries. The IPPR claimed that its reform proposals ‘could save taxpayers up to £205bn over the next decade by freeing up growing sums each year’.

Other recommendations in the report include striking a new deal with health and care workers which focuses on ‘better take-home pay’ and ‘stronger worker rights,’ as well as upgrades to digital and physical infrastructure. The last BMA’s Annual Representative Meeting (ARM) voted in favour of GP practices withdrawing from PCNs next year.

BMA View and the Labour Party

In June, GP leaders at the BMA wrote to the Labour Party in a bid to change its position on the future of the partnership model. There had been some confusion over Labour’s position on the GP partnership model earlier this year – with shadow health secretary Wes Streeting offering conflicting opinions. Labour party leader Sir Keir Starmer made the position clear in May when he said the GP partnership model is ‘coming to an end of its life’ and that the NHS needs ‘more salaried GPs’.

Cheshire LMC Comments

In a recent survey in part of Cheshire 95 GPs responded to the question ‘How important do you think the partnership model is for the future of general practice?’.64 said important, 24 had a neutral view, and only 7 said it was not important.

A question I am often asked is why I am so supportive of the independent contractor model of general practice. Wouldn’t life be easier and simpler for GP partners if they were free to operate as clinicians, without the distraction of trying to run a small business? For many the grass may look greener on the other side of the fence.

A place where GPs could work reasonable hours, take annual and sick leave like any other employee, and be free from all the stresses of income, cash, staff, and premises. Life looks so much simpler. Life on the other side will always contain its own set of different problems.

If you surrender your independent contractor status to become a salaried employee with an NHS organisation or service that will mean a surrender of power and the right to self-determination. You can no longer organise your work to best meet competing demands. You will no longer negotiate with equal partners but must accept the directions of management which may at times go against your own views. You no longer control what activities you can accept and reject. You must undertake the mandatory training as instructed by your senior manager. If you identify options for clinical or admin changes you will not be able to introduce these unless you gain authority from others to do so.

It is easy to think that you would just turn up for work, see the patients you were asked to and then leave at the end of your shift or contracted hours. Certainly, you will be at the receiving end of decisions made at an organisational level many levels away from your role.

The independent contractor model offers freedom for GPs and their staff to choose how they operate, to flexibly adapt to meet the needs of the patients they help, and to respond quickly to any new situation that arises and requires action. This has been a key strength of general practice, one that is not always well understood, but one that would be lost if the independent model were replaced. It not only enables practices to adapt and thrive in even the most testing circumstances, but also provides partners that need for self-determination that a salaried model would take away forever.

William Greenwood, governing body member of PCC and Chief Executive Officer for Cheshire Local Medical Committee.

Last Updated on 30 November 2023