Chris Lancelot: Double-edged sword of a salaried GP service

Last month was notable for three events: the launch of Change4Life, the DoH's project to tackle childhood obesity; the release of the new quality framework rules; and the suggestion by Welsh health minister Edwina Hart that GPs in Wales could all be salaried.

Doesn't a salaried GP service sound nice? I'm sure the government and the DoH are wildly in favour: it would enable them to control GPs as never before. But have they thought it through? The DoH can behave abysmally towards GPs without any comeback. Although we have to adhere to the detailed quality framework rules to get our money, it doesn't bother the DoH that, as usual, it has released them six months late.

Then there's Change4Life - an admirable project by all accounts. GPs will presumably need to be involved, though details are sketchy. But I'd like to bet that we will get no remuneration for any extra work and commitment involved.

In a salaried service this would all change. If the quality framework rules weren't in place then no one could be expected to adhere to them. Nor would learning about new initiatives or putting them into practice be done in our own time, at our own expense. Under a salaried service not only would GPs be paid for attending training but the DoH would have to fund our locums as well.

It would certainly have to make a start by buying us all out, and then upgrading our premises to a common high standard.

Suddenly a salaried service doesn't sound such a good idea for the DoH, does it? It's like revamping out of hours: the DoH must have looked forward to PCTs organising out of hours instead of those 'lazy' GPs - until they discovered just how expensive and downright inefficient it became.

In short, the DoH and the government don't have a clue about the difficulties, responsibilities and hidden costs of primary care, and the minute they try to control it themselves they will receive the biggest shock imaginable.

Come to think of it, maybe we should all clamour to be salaried. We wouldn't get taken for granted or let down half so much. We'd also have a maximum 48-hour working week, plus countless other benefits from sick leave to ergonomically correct workstations. The DoH wouldn't know what had hit it.

Dr Lancelot is a GP from Lancashire. Email him at

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