Chris Lancelot on…Becoming a salaried service

The media seems to be full of comments from high-profile medico-political GPs. Dr Eric Rose suggested in The Times that GPs are being softened up by the government for something — possibly the introduction of privatisation.

But it could be extended hours, or a salaried service.

Then there was Dr Simon Fradd's injudicious comment that the DoH's valuation of our out-of-hours  work at £6,000 a year was 'a bit of a laugh'. I didn't think it was funny at all - I felt very sad that the DoH thought we were worth so little. Work it out for yourself: they rated our on-call value at £1 an hour. Cast your mind back to that time the DoH was putting the boot in to get us to hand over our out-of-hours commitment. They made it very clear that if we relinquished on-call it was a one-way trip: there was no going back, under no circumstances, not ever. They wanted to wrest out-of-hours from our control - and look where it got them: a poorer-quality service that was vastly more expensive. 

I hope we are being softened up for a salaried service in which we are paid by the hour with overtime rates agreed beforehand. It would be the perfect antidote to those politicians and DoH officials who seem to think that GP time is a bottomless pit. Move secondary care to primary care? No problem, the GP will do it. Make GPs do all post-operative checks? Easy. Increase the quality framework requirements? It will drive up the standards of care. Make GPs produce more data for the primary care organisation (PCO) questionnaires, sit on more committees, have more meetings about practice-based commissioning, referral rates and prescribing habits? The GPs can do it. That is why they get paid £250,000 a year.

A salaried service will not work like that. At 6.30pm sharp we'll all go home. So there is a post-operative check to be done? Sorry, get the night staff to do it because I'm off. Need a GP rep at a PCO meeting? My apologies, but you know how it is. Want some more data? Well, normally I would, but there are all these diabetics to see. Yes, a salaried service might well prove a bit of a laugh.

- Dr Lancelot is a GP from Lancashire. Email him at

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