Dr Krishna Kasaraneni: General practice still needs independent contractor status

As part of a week-long series of blogs for GPonline by GPC members, education, training and workforce subcommittee chair Dr Krishna Kasaraneni says new models of care should build upon - not replace - independent contractor status.

An LMC conference themed debate on Thursday tackled a very big question: is it all over for the independent contractor model in general practice?

Time and time again, we hear that the sun is setting on this bulwark of general practice. It recently came up at the House of Lords select committee and the comments from there caused much debate, concern and not a little mudslinging.

Let’s start with some facts. In possibly the largest survey (over 15,000 responses) of the profession by the BMA last year, more than four in five (82%) GPs supported maintaining the option of independent contractor status for the profession. We also keep hearing that ‘new’ GPs and trainees want to work in ‘non-partnership’ roles from a variety of surveys and from ad-hoc feedback.

GP contracts

But let’s take a closer look at those facts. In the same survey, the majority of salaried GPs, locum GPs and trainee GPs all supported the option of independent contractors status. Chronic underfunding, ever increasing workload and dwindling workforce have all contributed to GPs choosing to leave partnerships and the number of whole-time equivalent GPs has now dropped down to levels before 2009.

This does not mean that GPs are choosing to abandon the partnership model - they are being forced out of it. The emergence of new models of care is also seen as a threat for the independent contractor model. Again, revisiting facts will demonstrate very clearly that these new models of care succeeded in places that built on the independent contractor model rather than replacing it.

So, where do the profession go from here.  We have two options:

  • Resign to the fact that the independent contractor model is being forced into submission.
  • Stand up for the independent contractor model and make it clear to the politicians that this is the model that the profession backs and force them to undo the damage and build on the model that has provided the best care for patients over many decades.

So let’s put this debate to rest once and for all. General practice is changing and GPs of the future will want to work in different ways to the past. But there is still a strong support for the independent contractor model and the profession wants it preserved and enriched. The powers that be that suggest otherwise are being at best ignorant, and at worst naïve.

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