Employing salaried GPs is destroying our future

I recently carried out locum work in a practice where a single-handed GP runs a practice with a list size of 9,000 (grown from 2,500 when he took over five years ago).

This doctor, nay businessman, employs three or four salaried GPs plus a trainee and the occasional locum to do the work. He is in a lucrative position; he is unlikely to give up his fiefdom unless the contract changes.

This sorry situation deprives new and older GPs opportunities to practise and learn general practice management, not to mention depriving them of income whilst subsidising the gains of the only 'partner'.

Are there any partnerships left that do not employ one or more salaried GPs? I doubt it.

The government supports private companies taking over management of primary care centres. These companies do not understand or respect continuity of care, medical education and the existing knowledge of general practice and its management systems.

They value profit. They employ salaried GPs and locums mainly found through agencies. These doctors are already complaining of feeling disempowered and unable to make decisions regarding patient management.

They will also become deskilled and subsequently compete with other lower-paid health workers such as nurse practitioners, just as the government wants.

Existing general practices are reneging on their responsibility to support the next generation of GPs through their unwillingness to recruit in the traditional way. Their selfishness in choosing to exploit the short-term financial rewards of the new contract by employing low-paid salaried GPs is ruinous to general practice and plays into the government's hands.

Weak negotiation by the BMA has also meant that there has been little opposition to private initiatives and little to counter the decreasing number or partnership positions.

Dr Vanda Playford, London.

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