Editorial: GPs need independent contract choice

It's difficult to imagine a more momentous time in general practice since the introduction of the new GMS contract in 2004.

Health secretary Jeremy Hunt wants a radical contract overhaul, including plans to make named GPs responsible for patients' health and social care around the clock, a 'dramatic simplification' of targets and incentives for GPs, and hospital savings shifted 'back into general practice to pay for higher levels of care'.

At Labour's annual conference in Brighton last week, Lord Philip Hunt, Labour's health spokesman in the Lords, called for GP contract reform, and the scrapping of GP-led commissioning and the purchaser-provider divide.

Change is inevitable. Practices face pressure on income, a DH survey has found almost one in 10 GPs aged under 50 plan to quit direct patient care in the next five years, and the profession's stress levels have soared to a 15-year high. A recent BMA poll found GP morale has collapsed in the past year as rising workload and bureaucracy have reduced time with patients.

GMS contract talks will no longer be carried out on a UK-wide basis from this year, in a move that could increase QOF variation and open the door to making GPs in England responsible for patient care around the clock.

We examine outgoing RCGP chairwoman Professor Clare Gerada's view that the case for changing GPs' contractor status is overwhelming. Should GPs give up independent contractor status? Email us your views at GPletters@haymarket.com

When practice income is under threat and workload is rising, independent contractor status could be argued to offer protection. Pressured GPs are at least safe in the knowledge that their destiny is in their own hands, although increasing QOF box-ticking can maximise practice exposure to negotiated, or latterly imposed, pain.

The ramifications of encouraging GPs away from independent contractor status are worth investigating. What is most important, as Professor Gerada acknowledges, is that GPs retain the choice to remain independent contractors if they so wish.

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