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Should all GPs become NHS employees?

BMJ 2016; 355 doi: (Published 05 October 2016) Cite this as: BMJ 2016;355:i5064
  1. Azeem Majeed, professor of primary care1,
  2. Laurence Buckman, GP partner2
  1. 1Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
  2. 2Temple Fortune Medical Group, London NW11 7TE, UK
  1. Correspondence to: A Majeed a.majeed{at}, L Buckman l.buckman{at}

Independent contractor status creates unnecessary stress, writes Azeem Majeed, but Laurence Buckman values his autonomy and distance from a non-benign employer

Yes—Azeem Majeed

It’s time that NHS general practitioners became NHS employees to end the anomaly that left GPs and their staff independently employed when the NHS was created in 1948.1

Currently, two main types of GPs work in the NHS: independent contractors (GP partners) and salaried employees. An increasing proportion of GPs are salaried employees rather than self employed independent contractors: about 28% (10 063/35 586) of GPs in England were salaried in 2015 compared with just 4% in 2002 (1085/29 202).2 3 However, salaried GPs are rarely employed by the NHS; generally, they are employed by other GPs or commercial companies.

A recent survey of 573 GP partners by Pulse magazine found that 51% would become salaried for the right deal.4 The employment contracts of salaried GPs vary hugely, and they often have worse terms than doctors employed by the NHS—for example, less maternity leave or sick leave provision. Salaried GPs would therefore benefit from a transfer to NHS employment contracts, as would GPs who are currently self employed.

Most stressed

Primary care in England’s NHS is in crisis.5 6 Recruitment of GPs is difficult throughout England, with many practices reporting vacant posts; many GPs are considering retiring early, and others want to cut down on their clinical work.7

In a survey of primary care carried out by the Commonwealth Fund in 11 countries GPs in the UK were the most stressed.8 UK GPs also reported high levels of dissatisfaction with their style of work—for example, the short consultation lengths and high number of patient consultations a day in the UK (92% of GP consultations in the UK were less than 15 minutes compared with just 27% in …

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