Save our Souls

I regularly refer to General Medical Practice not only because I feel affinity to GMPs but also because I fear that in the future some PCTs and service commissioners will learn to apply the worst of each system. In order to control health professionals they will drive down costs, encourage a dumbed down service and bring about a short term approach.

The points raised are starting to apply to new dental graduates.

The Orwellian phrase “World Class Commissioning” comes to mind.

My brother sent me this piece from a recent BMJ

Published 7 April 2009, doi:10.1136/bmj.b1420
Cite this as: BMJ 2009;338:b1420

Views & Reviews

From the Frontline

Save our souls

Des Spence, general practitioner, Glasgow

Let’s dispense with the normal pleasantries: what the hell is going to happen to all our recently qualified general practitioners? Locum work is drying up, out of hours rota sessions are full, the only permanent jobs are salaried positions, and GP partnerships seem to be coming to an end. Why is all this happening?

The reasons are several. In the mid-1990s a shortage of doctors led to an expansion of medical schools’ intake; this expanded cohort of doctors is now completing specialist training. Furthermore, after the Modernising Medical Careers (MMC) debacle in 2007 a large number of hospital doctors moved sideways into general practice. So more GPs were produced. But just as this is happening, the employment changes resulting from the 2004 GP contract arenow being felt. At one time there were no salaried positions, with regulations stipulating it was to be partnerships or nothing. And there were large financial incentives to take on new partners.

But now practice finance is completely deregulated, with just one big tempting pot of cash. So, for instance, why not make savings on reception staff and keep the money? If the practice needs additional clinical time, why not employ a lower cost salaried doctor or, better still, a specialist nurse and pocket the difference? Why retire? Or you could drop the pain of clinical commitment and “manage” a salaried horde. Few partnerships are being offered, because the current partners would be financially stupid to do so.

The result is an increasingly resentful group of new GPs who are offered no career progression, are effectively disenfranchised from the GP community, and are left scrabbling for shrinking amounts of locum and out of hours work. Add in the recession’s squeezing effects on use of locums, and the law of supply and demand will see locums’ pay rates fall and the financial situation of new GPs become ever more dire. This is not a crisis yet, but it will be. What should we do: appeal to the benevolence of the currently encumbered partners? This will not work.

I propose a solution to which I am willing to put my energies. We all know that the quality and outcomes framework (QOF) is stupid, paper shuffling nonsense. So half of QOF payments should be used to encourage new partnerships, as real quality of care is born of continuity and access to well trained, committeddoctors. Secondly, salaried contracts should be a “partnership with a view,” with a defined run in of a year, giving proper career progression. Without young partners, traditional general practice in the United Kingdom will die.

GPs are becoming salaried zombies enduring an eternity of centralisedpolyclinic hell. This situation is wrong, and the time has come to protest. Picketing the conference of local medical committees in June might be a start.

Cite this as: BMJ 2009;338:b1420

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