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Is it time to rethink the independent contractor status of GPs

Is it time to rethink the independent contractor status of GPs in areas of the UK where general practice is struggling? Mixing funding for patient services with funding for GP remuneration can lead to government reluctance to invest more in primary care for fear that money intended for service improvement will end up boosting GPs’ incomes. As practices close, it becomes clear that an individual practice is often too small a unit to carry the risk of unpredictable financial burdens such as maternity or sick leave. Ultimately, patients suffer, particularly in inner city or rural practices that receive little financial allowance for deprivation within current funding arrangements, and it is unlikely that a new “fairer funding formula” will rectify this.

The knock-on effects of the funding shortfall in these struggling practices are seen in the difficulties they have in recruiting GPs. Young doctors want clear job plans, career progression, time for management and clinical leadership, and guaranteed employment rights. These aspirations can be made real only by developing NHS primary care provider organisations that employ GPs and practice staff on mandatory NHS contracts. We need to act before NHS general practice becomes non-viable as it risks doing so in many parts of the UK. Placing GPs and their primary care teams on NHS contracts won't be a cheap option but it may be needed to 'rescue' general practice in the parts of the country where it is currently struggling to meet patient needs and expectations.

A version of this blog was first published in the BMJ.


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