Some people are saying that GPs would be better off as a salaried service, being employed by hospital trusts or private contractors. It feels like swimming against the tide to stay with the current GMS contract even though that gives us stability and has to be nationally negotiated. Rather than just disagreeing I want to understand why they think we should accept the change.
Why would we be better off salaried and trusting HMG / NHSE?
- They will look after us and never take advantage of us
- They care about evidence and what works
- Their highest concern is the wellbeing of our patients and communities
- They will take responsibility for the effects of their actions
- They can see the future better than we can
- They will stop attacking us in the press
- They will never force us do things just for political gain
- They will listen to us and negotiate fairly with us as employees
- They will never renege on their promises
- There is no choice because it is impossible to make a living as a GP partner
The problem is that I don’t think any of these things are true – in fact exactly the opposite. But why haven’t we become salaried already? Are there any economic reasons why partnerships keep going?
Things we would lose if we became salaried
- Premises rental income – over time, the increase in the value of premises pays the interest on the mortgage so the notional rent is simply extra income.
- Dispensing income – profits that would go to pharmacists in urban areas.
- Non NHS income – police work, employment medicals, private work for individuals and businesses – well paid so they subsidise NHS care.
- Management savings – practices can run with very lean management costs because partners take responsibility for the business.
- Innovation, team building, patient trust – having the business owned by local clinicians means that they can make improvements without having to ask permission. And they can also choose not to implement harmful directives from HMG / NHSE. These can significantly reduce costs and workload.
This funding doesn’t only benefit the partners. Keeping this income in practices allows them to afford more staff and to pay them better.
Would becoming a salaried service be a one-way trip?
The alternative to swimming against the tide is to just let locally owned General Practice go. We can sell our buildings, give up our GMS contracts and get jobs with hospitals or private companies. But if we did this, would it ever be possible to buy our surgeries and have our GMS contracts back? Would they ever let us become autonomous surgeries who didn’t have to do everything we were told? If you think this would be a permanent loss you need to think very carefully.
When out of hours care was taken away from GP led CAMDOC / UCC our base was fairly swiftly moved from purpose-built premises with good free parking in the heart of our community to a repurposed outpatient clinic near A&E. This was not good for our patients and seemed to be solely to reduce A&E costs, but we were powerless to stop it. If we hand them control will there be anything we can do if our employers decide that local GP surgeries should be closed?
It all depends whether you think that hospitals and private providers will look after General Practice clinicians and patients better than locally owned surgeries. This is a particularly important question for younger GPs as you are likely to be stuck with the consequences for the rest of your careers.
Swimming against the tide may require effort but it beats crashing against the rocks.