Chris Lancelot on self-employment in the NHS

There are times when it's good for GPs to be self-employed, and this isn't one of them. The advantages of self-employment are huge. Self-employed people can run their lives the way they want. They claim a much wider range of expenses against income tax. They can choose their own work/lifestyle balance and also benefit from investment in their own business.

The downside is that the self-employed have little protection if their contract provider decides to change the rules of engagement. Indeed, at a time when it seems impossible to sack an employee without ending up on the wrong end of an employment tribunal, contracted workers can be bullied and pushed around at will.

In the NHS, self-employed GP principals are rapidly becoming second-class citizens. Unlike employed workers, GP principals are expected to take on ever more work for an ever-decreasing reward. Legally you can't sack an employed worker without an incredible amount of fuss, red tape and rigmarole: but it is all too easy for primary care organisations to impose contract changes on self-employed GPs without any comeback whatsoever.

PMS practices at one time enjoyed a protected contract income: now Suffolk PCT is threatening to terminate their contracts if they don't accept massive pay cuts - and where Suffolk leads, others with surely follow.

In the same vein, just four years ago the government asked GPs to vote on a new contract which for the first time included a fixed maximum work period. That same government has now made it clear that it would like unilaterally to tear up this agreement and extend our opening times, which will inevitably mean the imposition of longer and/or more unsociable hours - dreadful for all GPs with young families.

Perhaps it is time to remind Gordon Brown that just because GP principals are self-employed it doesn't mean the government is entitled to treat them like dirt. Can you imagine the outcry if the government announced that from next year all salaried council employees would be forced to work late, so the general public could contact their council on returning from work?

How convenient for Brown that the practice staff costs of extended opening will fall on GP principals rather than on the NHS. Now is not the time for GPs to be self-employed.

Dr Lancelot is a GP from Lancashire. Email him at

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