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General practice is a difficult place to be right now. The BMA GPs committee’s survey of GPs in England clearly exposes the impact of the current workload and workforce crisis, in large part related to the failure over the last decade to provide the necessary funding to match the rise in people needing to access general practice services.
With more patients living with increased complexity and increasingly turning to practices rather than hospital specialists for their care, there is an urgent need to address the fundamental funding problem.
However the survey is also clear that, despite the many problems, GPs believe that the current independent contractor model of individual practices is worth retaining and building on and should be the prime model for general practice in the future, whilst recognising that resources are also needed for practices to collaborate in the form of GP federations/networks.
As independent contractors, GPs are in direct contact with, and accountable to, those who use their service, often committing to their practice and local community for the long-term, providing continuity of care from one generation to the next. They not only know their patients and families, they are part of the community.
As a result it’s in the direct interest of the GPs running the practice to ensure they deliver what their patients need and to do it as effectively and efficiently as possible. Overwhelmingly GPs achieve this, as demonstrated by consistently higher levels of satisfaction than other parts of the public sector.
GP partners work together, going the extra mile to get the work done. Although commissioners have exploited this by failing to resource rising workload, GP contractors are empowered clinicians, with a degree of autonomy no longer enjoyed by many employed NHS colleagues, and can use this to decide for themselves what they do and don’t do. It also gives GPs far more freedom to publicly stand up and advocate for their patients.
Being independent enables practices to be flexible and to quickly adapt to the latest policy change or yearly contact changes. It’s why many practices are at the leading edge of healthcare innovation, as seen with GP IT systems being years ahead of those in hospital settings.
The survey also makes clear that whilst many GPs want to work in a salaried capacity they also want the option to become a partner at some point in their career. Equally even those who want to continue as salaried GPs prefer to be employed by an independent contractor practice.
However the traditional way of working is under threat as many practices struggle to cope with the tidal wave of increased bureaucracy and spiralling workload. As our survey shows, most are now seeing the benefit of working in collaboration with other practices in their area to share resources and provide greater sustainability and security for each member practice.
New models of sharing staff across a group of practices mean all can benefit from the expertise of other healthcare professionals such as pharmacists and therapists. Many groups have also used collaborative models to deliver appointments on evenings or weekends without placing any requirement on individual GPs to work in ways they do not want to do.
The reality is that general practice, built around independent contractors looking after a registered list, is why the NHS has remained sustainable since its creation. In an uncertain future, GPs can build on this by working together with others in their area and supporting one another. However any attempt to undermine this foundation risks the whole NHS house collapsing.
Richard Vautrey is BMA GPs committee deputy chair
Read the full survey results