Skip to main content

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.

Comments

Popular posts from this blog

Improving how secondary care and general practice in England work together: the NHS Standard Contract

Due to the increasing pressures on general practices within the National Health Service in England, the interface between primary and secondary care, and the division of labour between these, has become an important issue. This has long been an area prone to difficulties and conflict, the consequences of which can directly impact the quality and safety of patient care, particularly for patients with chronic conditions who regularly transition between these two sectors. In an article published in the Journal of the Royal Society of Medicine, Amy Price and I explore the measures recently implemented in the NHS Standard Contract which aim to target common issues at the primary–secondary care interface, with an aim to reducing inappropriate general practitioner workload in England. We discuss the context behind the implementation of the NHS Standard Contract as well as current concerns and areas for further consideration.

The current crisis in primary care means the NHS Standard Contract…

Patients are more satisfied with general practices managed by GP partners than those managed by companies

General practices in England are independent businesses that are contracted to provide primary care for specified populations. Most are owned by general practitioners, but many types of organisation are now eligible to deliver these services. In a study published in the Journal of the Royal Society of Medicine, we examined the association between patient experience and the contract type of general practices in England, distinguishing limited companies from other practices.

We analysed data from the English General Practice Patient Survey 2013–2014 (July to September 2013 and January to March 2014). Patients were eligible for inclusion in the survey if they had a valid National Health Service number, had been registered with a general practice for six months or more, and were aged 18 years or over. All general practices in England with eligible patients were included in the survey (n = 8017).

Patients registered to general practices owned by limited companies reported worse experience…

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 …