I thank Sir Denis Pereira Gray for his thoughtful comments. Sir Denis has been a long-standing and very prominent advocate for primary care. I acknowledge that there are many benefits for GPs being self-employed and I have listed some of these in a previous article.[1] For example, GPs do have more freedom to speak out about health services than salaried employees of the NHS. It is also true that many professional groups – such as accountants, architects and surveyors - work in partnerships as self-employed practitioners. One key difference between these groups and GPs is however that a typical general practice obtains nearly all its income from one funder: the NHS. This gives the NHS considerable power over GPs and the ability to unilaterally modify contracts, confident in the knowledge that GPs have to either accept the terms the NHS is offering or give up their contracts.
The current reality in the NHS is that an increasing number of GPs are finding it difficult to work as GP partners.[2] Their clinical and administrative workload is increasing, they are having to take on greater clinical risk, and the NHS is placing an increasing regulatory burden on them. Unless these problems are addressed, there will inevitably be a decline in the number of GPs who want to be partners in a medical practice. Hence, it seems inevitable that we will see a continuing increase in the number of GPs who are salaried employees. I would prefer these GPs to have a standard national contract rather than the very variable employment terms offered by the commercial providers of primary care.
Rapid Response:
Response to Sir Denis Pereira Gray
I thank Sir Denis Pereira Gray for his thoughtful comments. Sir Denis has been a long-standing and very prominent advocate for primary care. I acknowledge that there are many benefits for GPs being self-employed and I have listed some of these in a previous article.[1] For example, GPs do have more freedom to speak out about health services than salaried employees of the NHS. It is also true that many professional groups – such as accountants, architects and surveyors - work in partnerships as self-employed practitioners. One key difference between these groups and GPs is however that a typical general practice obtains nearly all its income from one funder: the NHS. This gives the NHS considerable power over GPs and the ability to unilaterally modify contracts, confident in the knowledge that GPs have to either accept the terms the NHS is offering or give up their contracts.
The current reality in the NHS is that an increasing number of GPs are finding it difficult to work as GP partners.[2] Their clinical and administrative workload is increasing, they are having to take on greater clinical risk, and the NHS is placing an increasing regulatory burden on them. Unless these problems are addressed, there will inevitably be a decline in the number of GPs who want to be partners in a medical practice. Hence, it seems inevitable that we will see a continuing increase in the number of GPs who are salaried employees. I would prefer these GPs to have a standard national contract rather than the very variable employment terms offered by the commercial providers of primary care.
References
1. Majeed A. Arguments in Favour of an Independent Contractor Model of General Practice. http://medical-centre.blogspot.co.uk/2013/10/arguments-in-favour-of-inde...
2. Majeed A. Primary care: a fading jewel in the NHS crown. London Journal of Primary Care 2013;7:89-91. http://www.tandfonline.com/doi/full/10.1080/17571472.2015.1082343
Competing interests: I am a GP Principal in an NHS general practice that employs salaried doctors.