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Tendering out general practice is bad for doctors—and patients

BMJ 2012; 344 doi: (Published 18 April 2012) Cite this as: BMJ 2012;344:e2461
  1. Katy Gardner, general practitioner, Marybone Health Centre, Liverpool Community Health NHS Trust, Liverpool L3 2BG
  1. katyagardner{at}

I have been a general practitioner (GP) for 34 years, and I was a GP principal long ago. In 1998, while working in an inner city practice in Toxteth, Liverpool, my colleagues and I were finding it increasingly difficult to recruit GPs, and we decided to become a pilot salaried practice. We were a group of dedicated and enthusiastic GPs but did not excel at business and were not always comfortable with our independent contractor status. Initially, we chose to be employed by our local community mental health organisation, North Mersey Community NHS Trust. Immediately we could attract high quality salaried GPs who wished to work in the inner city, who recognised that providing a high quality service in a deprived diverse area did not always attract money through the general medical services contract, and who were keen to be part of an exciting new way of working.

Fourteen years on, were we right? Over the past six months, I have experienced the full downside of this decision. I have been “out to tender” …

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