Chris Lancelot: Do not deter the brightest new doctors

The law of unintended consequences has just hit primary care. Under the old-style GMS a significant part of practice income depended on the number of partners they had. Taking on a new partner attracted considerable extra remuneration, whereas to employ the same doctor as a salaried assistant was usually just an expense.

As a result there was constant pressure on the Medical Practices Committees to allow practices to take on new partners.

But the now-universal introduction of PMS, new GMS and APMS contracts has destroyed this link completely.

Remuneration based on weighted demographics has allowed practices the freedom to decide how best to service their populations' needs. It has led to more flexible and locally appropriate practice workforce structures.

But these new-style contracts also contain a hidden flaw: they encourage practices to minimise the number of partners. Indeed, under APMS almost all GPs will be salaried.

As a result the number of partnership vacancies has dropped. It has all been for understandable economic reasons: after all, why shouldn't partners maximise their drawings by employing a salaried doctor rather than having a new and expensive partner? Unfortunately for the new doctor, salaried GPs are paid much less than partners, sometimes as little as £40,000 per year.

Although salaried status is welcomed by a proportion of GPs, many newly-trained GPs are now becoming disillusioned: they can neither find a partnership nor realise their expected earnings potential. Word of their disenchantment has spread. This year applications to vocational training courses have dropped by 30 per cent, though low pay for salaried GPs is not the only reason.

Clearly, no-one can blame existing partners and businesses for taking sensible economic steps to maximise their rewards: they are reacting as anyone would.

This situation needs to be reviewed. The NHS won't want to change its contracts to remunerate partners; and a legally-binding minimum wage for salaried GPs will be limiting on the less wealthy practices. The future of general practice will once again be uncertain if the brightest and best new doctors are deterred from considering it.

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