Federate or lose independent contractor status, Northern Ireland GPs warned

GPs must back federations or risk losing their independent contractor status to the threat of integration, Northern Ireland's top GP has warned.

Dr Tom Black: federations key to future of general practice in Northern Ireland (photo: Jason Heath Lancy)
Dr Tom Black: federations key to future of general practice in Northern Ireland (photo: Jason Heath Lancy)

Addressing LMC representatives at the Northern Ireland LMCs conference in Newcastle, County Down on Sunday, Dr Tom Black warned that general practice faced a ‘significant risk’ from health service integration which threatened the loss of autonomy and control for practices with ‘most GPs losing independent contractor status and becoming salaried doctors’. ‘This would not be good for the profession or the service for patients’, he said.

The current dynamics of workload and workforce made this a real risk, said GPC Northern Ireland chairman Dr Black, and he called on all GPs to take ‘ownership’ of the development of federations as the solution.

Federations, he said, could help control the shift of care from hospitals, the delivery of GMS-plus services, develop collaborative networks, and coordinate community nursing, and out-of-hours services.

GPC Northern Ireland has been organising pilot federations and expects to have up to five federations in each LMC area within six months.

He said: ‘GP federations will co-ordinate the management of workload in primary care, rationalising patient access, integrating with out-of-hours services and emergency departments to ensure appropriate care for patients. Federations can also be used to develop innovative services in the community for the frail elderly, nursing home patients and those with complex needs.

‘This type of service can be difficult to develop in a single practice but could be developed in a federation. A significant part of what is traditionally viewed as hospital  outpatient and diagnostic services could be managed or provided in the community by federations.’

UK GPC chairman Dr Chaand Nagpaul said GPC Northern Ireland’s federations plan was a ‘key policy which I think you should embrace’.

In England, he said, sessional doctors felt disenfranchised by CCGs, so it was important for all GPs to have a sense of ownership of federations. 

Northern Ireland, said Dr Nagpaul, had a ‘fantastic opportunity’ to create federations without the ‘contamination’ of CCGs, which created difficulties with the same GPs commissioning and providing services.

‘It’s about GP practices supporting other GP practices,' he said. ‘And that’s something we need to be looking towards: a sense of collective ownership, of making general practice more bearable.’

There was ‘enormous potential’ he added, for practices to share resources, staff, and management.

Conference delegates backed unanimously a resolution welcoming the development of federations, insisting GPC Northern Ireland policy supports the development of individual practices providing GMS services at the core of federations, instructing GPC leaders to support the opportunity for every GP to be involved in federations, and calling on the government to invest in primary care infrastructure to allow federations to flourish. 

Dr Windsor Murdoch of Northern LMC said GPs must apply to ‘every practice', and ‘practices of all types’, in order to bring benefits. They must, he said, ‘develop practices' unity, and support their diversity’.

Eastern LMC representative Dr Grainne Bonnar said GPs needed a new funding model and federations would ‘provide a vehicle for funding to come into general practice’.

Dr Black called federations the ‘most important thing we are dealing with’ for progressing general practice. ‘This is the game changer,' he said. ‘We now need the board and the department to overcome their inertia and engage with us.’

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