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Should we fight to preserve the independent status of general practitioners?ForAgainst

BMJ 1999; 318 doi: (Published 20 March 1999) Cite this as: BMJ 1999;318:797

Should we fight to preserve the independent status of general practitioners?

Primary care in Britain is set to change again from 1 April. England, Wales, and Scotland have different sets of reforms, but general practitioners in all areas will soon be working together in new groupings that could lead these doctors into salaried rather than independent contracts with the NHS. Here, two members of the BMA's General Practitioners Committee argue the pros and cons.

Editorial by Oldham and Rutter


  1. Roger Chapman (, general practitioner
  1. 29 Bassett Road, Leighton Buzzard, Bedfordshire LU7 7AR
  2. Pelaw Medical Practice, Gateshead NE10 0RR

    The special status that most general practitioners have enjoyed in the NHS for 50 years is under threat. Until now most general practitioners have contracted independently with health authorities and their predecessors to provide primary care, rather than being salaried employees. Working together as principals in practices has not affected this independence. But from April all general practitioners in England and Wales, and some in Scotland, will join together in large local groups that could signal the end of the independent contractor.

    Many general practitioners feel that their independence is increasingly illusory and believe, despite protestations to the contrary, that governments have always resented the freedoms and privileges of this special status. The general practitioners' revised contract in 1990 ushered in an increasingly managed service. The Primary Care Act 1997 enabled alternative models of primary care, often where traditional practices no longer met the needs of local people, and encouraged salaried options.

    The move to primary care groups and the prospect of rapid progression to primary care trusts signal a big …

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