Intended for healthcare professionals

Feature Commentary

Independent or employed? There is a third way. . .

BMJ 2016; 355 doi: (Published 05 October 2016) Cite this as: BMJ 2016;355:i5329
  1. Des Spence, general practitioner
  1. Maryhill Health Centre, Glasgow, UK
  1. destwo{at}

General practice is in crisis. Many posts lie empty and large numbers of older doctors are due to retire soon. The current system is failing, with patients waiting weeks for appointments. Something radical has to be done. Currently we are small groups of self employed doctors with limited career progression, a blank cheque of responsibility, and seeing in excess of 30 patients a day in 10 minute appointments.1 The combination of acute and routine work required means that GPs often finish surgeries then do house calls over lunchtime. Paperwork is done in the margins of the day. Increasing pressure is making general practices dysfunctional, chaotic, unhappy, and lonely places. A sickness absence can …

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