GPs are not directly employed by the NHS. GP principals (who usually work in partnerships and may themselves employ other, salaried, GPs) are contracted to NHS England for the work that they do. They are free to undertake private work (such as providing insurance and legal reports) but the vast majority of their work is for the NHS.
Therefore, GP principals are in the unique position of deriving the vast majority of their income (from which they will also have to pay for their expenses such as nursing and administrative staff) from one employer but being independent contractors.
GP principals have a great degree of autonomy over how to run their practice (which NHSE and governments may find frustrating) and are motivated to work long hours (sometimes longer than healthy) completing the work their patients need from them. They can be well rewarded but also carry the risk for employing their staff: if the practice fails financially, they can be personally liable.
As such, GPs as independent contractors offer unparalleled value for money for the NHS.
Unfortunately, in recent years, the work required has mushroomed and the funding, as in much of the public sector, has been squeezed. As such, the responsibility, workload and risk has been daunting for many. Many GPs have left the workforce and not enough have been trained. There has been a reluctance in some cases to share profits with newer colleagues even if they wanted partnership.
Consequently, unless substantial new resources are forthcoming, the model of employing GPs as independent contractors is under threat.
In the report of the House of Lords Select Committee on the Long-term Sustainability of the NHS, it was suggested that the independent contractor status of GPs as a model of funding was "not fit for purpose" (page 23 para 71). This is only because of years of the model being sabotaged, some would argue deliberately.
What is urgently needed is proper funding for General Practice, otherwise the ICS model will be only one of the first casualties. Certainly, without new resources, we will in the interim need to find new and less efficient ways of working, probably using directly employed GPs and other staff.
My declarations of interest
I have been a GP for nearly 13 years, of which 4 have been as a partner of a large multisite partnership (Midlands Medical Partnership). I am currently a salaried GP at Sandbach GPs, Ashfields Primary Care Centre and am looking for a partnership to join, as I believe in the ICS model and that it has a future. I am standing for re-election to the Council of the Royal College of General Practitioners.)
Tuesday, 11 April 2017
Friday, 24 February 2017
Storm Doris notwithstanding, there was a packed agenda. In a departure from tradition, education and innovation items were considered before politics, which allowed for more focus on the former.
I asked for some detail relating to the implementation of a change of administrative policy that had caused concern in my Faculty.
I welcomed an excellent paper from the ethics committee summarising not only the limitations of referral management but also of the drivers of increased activity and financial pressures that are often blamed unfairly on GPs.
They reached the conclusion, important in my view, that prioritisation should be explicit, even though this is politically unacceptable. This supports my long-held view that, as well as healthcare funding, the electorate must consider the remit of the NHS. I called for College to campaign for prioritisation to be considered explicitly, perhaps as part of the ongoing Put Patients First campaign.
RCGP Clinical Priorities 2017-2020
Council approved the following clinical priorities: cancer (to March 2022); liver disease, mental health, physical activity and lifestyle, and sepsis (to March 2019) as well as a number of 12 month "spotlight projects".
I questioned how the recommendations of each project would be weighed against the five tests of overdiagnosis agreed by Council in 2015. It was agreed that the RCGP Overdiagnosis group would be kept updated on the work of the Clinical Innovation and Research Centre.
Fellowship and beyond
A discussion paper was presented on ideas to improve the uptake of fellowship across the demographic of College members, and College might support continuing professional development for fellows.
I reiterated my view that fellowship should be open to all GPs, including those who are not existing RCGP members. I also expressed concern that a CPD programme might lead to "higher" designations of fellowship, thus devaluing fellowship itself.
*update: I have since joined the FRCGP short life working group seeking to inform policy in this area.