Skip to main content

Arguments in Favour of an Independent Contractor Model of General Practice

I have written an article on why GPs should consider giving up their independent contractor status and become NHS employees, which was published in Pulse. In this blog post, I will make the opposing argument and will list reasons why we should retain the current independent contractor model of general practice. This will be helpful for those GPs who are against the proposal that we should become NHS employees but who are unable to put together a coherent or logical counter-argument. If anyone has further arguments in favour of the independent contractor model, please let me know and I will add them to the list.

1- The independent contractor model is very efficient. For between 8-10% of NHS spending, general practices deal with up to 90% of patient contacts in the NHS.

2- Because GPs are not NHS employees, they have more freedom to act as patient advocates and to speak up about deficiencies in the NHS.

3- The independent contractor model gives GPs a stake in their practices and encourages them to take a long-term view about the services they provide and to build links with the local community.

4- The independent contractor model encourages continuity of care. Salaried GPs would work shifts and be less interested and capable of providing continuity of care.

5- General practices can operate very flexibly under their current model and respond quickly to changes in national NHS policy, or to local needs and priorities.

6- GPs have freedom as to where they refer their patients. If employed in integrated care organisations that encouraged vertical integration of services, there would be much more limited options available for referrals to specialists.

7- The independent contractor model has encouraged innovation in the delivery of care and the use of information technology. One example of this is the universal use of electronic health records in primary care, in contrast to other settings where paper records often remain the norm.

8- Most GP Principals are very hard working and work well in excess of the hours worked by salaried NHS staff. They also undertake a much wider range of tasks than salaried NHS staff.

9- Replacing the independent contractor model with a salaried GP service is likely to end up costing the NHS more, as salaried NHS GPs would work shorter hours, be entitled to employers' pension contributions, and benefits such as maternity pay, sick leave, holidays, and study leave.

10- GP Principals are less likely to take sick leave than salaried NHS employees.

11- Replacing GP Principals with salaried GPs would make general practice less attractive as a career for medical graduates.

12- Many practices operate out of premises they own. Buying them out of their current premises or moving them to NHS premises would be prohibitively expensive for the NHS.

13- Relocating patients to new NHS premises would be inconvenient for patients, particularly those that may have difficulty in travelling such as the elderly and families with young children.

14- GPs current freedom to practise medicine and run their practices as they feel is most appropriate would be replaced by control by NHS managers thus creating a much more rigid and inflexible model of healthcare delivery.

15- Salaried GPs would be paid substantially less than GP Principals, particularly if employed by commercial organisations rather than the NHS.

16- It's not the independent contractor model that's 'broken' but rather the funding model. We need a fairer method of funding primary care that gives GPs adequate resources to do their job well. See my recent JRSM editorial.

17- A fairer funding model for general practices would also help to ensure that sufficient staff are employed in primary care to meet patients' needs for care, and that patients are treated in community settings whenever possible, thus reducing demands on emergency departments, hospital outpatients, and emergency inpatient care.

You can also read the opposing argument on this blog. See also my JRSM editorial: General practice in the United Kingdom: meeting the challenges of the early 21st century. Another article  by me on the challenges facing NHS GPs in England was published in the London Journal of Primary Care in September 2015.The BMJ also published a 'Head to Head' debate article on this topic in October 2016.


Popular posts from this blog

Can GPs issue private prescriptions to NHS patients?

The NHS prescription charge in England is currently £8.60 per item. At this level, many commonly prescribed drugs will cost less than the prescription charge and so some NHS patients may occasionally ask if they can have a private prescription rather than an NHS prescription.

In the past, some GPs have been advised that they could issue both an NHS FP10 and a private prescription, and let the patient decide which to use. But the British Medical Association's General Practice Committee has obtained legal advice that said under the current primary care contract, GPs in England may not issue a private prescription alongside or as an alternative to an NHS FP10 prescription. In any consultation where a GP needs to issue an FP10, the concurrent issue of a private prescription would be a breach of NHS regulations.

The issuing of a private prescription in such circumstances could also be seen as an attempt to deprive the NHS of the funds it would receive from the prescription charge. Fur…

What will Brexit mean for the NHS?

On the 29 March 2017, the Prime Minister of the UK Theresa May, formally notified the European Union (EU) Council President, Donald Tusk, of the UK’s intention to leave the EU. Theresa May’s letter to Donald Tusk triggers a two-year process during which the UK will have to negotiate both the terms of its exit from EU and the arrangements that will replace those we have had for over 40 years with the other member states of the EU. The consequences of the United Kingdom’s departure from the EU (commonly referred to as ‘Brexit’) will be wide-ranging and will affect all areas of UK’s society, including the National Health Service (NHS).

For the NHS, Brexit comes at a time when it faces many other major challenges. These include severe financial pressures, rising workload, increased waiting times for both primary care and specialist services, and shortages of health professionals in many key areas (such as in general practice and in emergency departments). The NHS also faces challenges fr…

Dr Demis Hassabis, Co-Founder and CEO of DeepMind, Speaks about AI in Healthcare

On 28 September 2017, I attended the Annual Institute of Global Health Innovation Lecture: Artificial General Intelligence and Healthcare, delivered by Dr Demis Hassabis, co-founder and CEO of Google DeepMind. Artificial intelligence is the science of making machines smart argued Dr Hassabis, so how can we make it improve the healthcare sector? Dr Hassabis then went on to describe the work that DeepMind was carrying out in healthcare in areas such as organising information, deep learning to support the reporting of medical images (such as scans and pathology slides), and biomedical science. Dr Hassabis also discussed the challenges of applying techniques such as reinforcement learning in healthcare. He concluded that artificial intelligence has great scope for improving healthcare; for example, by prioritising the tasks that clinicians had to carry out and by providing decision support aids for both patients and doctors. Dr Hassabis also discussed some of the ethical issues in using …