Current contract 'harming GPs', warns former RCGP chair

General practice should switch to a salaried model to limit hours and intensity of work because the current contract is harming doctors, a former RCGP chair has warned.

Professor Clare Gerada (Photo: Pete Hill)
Professor Clare Gerada (Photo: Pete Hill)

Speaking in a head-to-head debate at the RCGP annual conference on the theme 'This house believes that the future of general practice lies in the partnership model', Professor Clare Gerada argued that the existing GP contract had 'trapped' doctors.

She told the conference that although she herself was a partner within a large multisite GP practice, she believed the partnership model was 'an outdated, romantic model entirely responsible for the problems we have in our profession today'.

Partnership-based general practice had served the profession well, she said - providing 'continuity and stability for decades'. But she argued: 'We are in different times - GPs want more flexibilty, more control of their lives, patients want more accessible care - we need a paradigm shift.'

Salaried model

Dr Gerada said she had long argued for a 'new career structure for GPs', with protected time for learning, a chance to develop special interests as part of a 'new salaried GP contract for us all akin to what we see for hospital doctors'.

'If we do this right we can have the best of all worlds - a decent contract limiting the hours and intensity of our work as well as professional not financial ownership of our primary care organisation - do this and we get out of the mess we are in and we can create a sustainable future for the next generations of GPs and patients.'

She added: 'We have trapped ourselves with the partnership model. We have trapped ourselves when we think we have autonomy and flexibility and independence when in fact we have a contract harming the people working in it. I think we need a salaried contract from the government saying what general practice should and shouldn’t be doing.'

Arguing for the partnership model, however, Dr Mike Holmes told the conference that he had been a partner since the day he qualified 18 years ago - and saw it as his 'past, present and future'.

Finacial risk

He accepted the model had to change - but said that practices like his own - a large 20-partner practice in which not all partners were GPs - had begun to make changes to tackle factors that could deter young doctors from joining.

'I am seeing an evolution in partnership - we are seeing risks in partnership addressed. In my practice we are transferring the partnership property into a corporate and renting it back to the practice. We are removing financial risk from the personal space and moving it into the limited liability space.

'That means no financial investment for young doctors, no buy-ins required for young partners.'

He added that the practice had a scheme to bed younger partners in gradually to 'flatten the learning curve' - and that was 'normalising portfolio careers'. He argued that it was time to drop the term 'portfolio' - and to accept that in modern general practice 'variation is just what we do'.

Dr Holmes said 'people and agility' were the two major benefits of the partnership model - relationships with patients and partners who had supported and encouraged each other over many years.

He added: 'We own the practice and have a commitment to it and to our patients. We can make decisions and act on them. We can decide something at 8am and have it implemented by lunchtime. I do recognise not all partnerships are thriving and it is hard times.

'But I believe through shared learning and collaboration we can achieve a model that not only survives but thrives.'

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