Interview: Salaried GP service working at scale is the future, says GP/MP

The latest addition to the ranks of GPs serving in parliament is ready to stand up for primary care - but is adamant that support must come with reform. Stockton South MP Dr Paul Williams talks to GPonline in one of his first interviews since his general election win.

Dr Paul Williams (Photo: Labour)
Dr Paul Williams (Photo: Labour)

‘I like this election thing,' Dr Paul Williams laughs. ‘I've only ever stood in two elections and won them both.'

Stockton-on-Tees GP Dr Williams was among 33 new Labour MPs who defied expectations last month to gain seats for the party, taking the Stockton South constituency in County Durham from the Tory incumbent in the first election he had ever run in.

Less than six weeks after his surprise victory, Dr Williams is busy setting up his office and getting to grips with parliament. The day before the House of Commons rises for summer recess, he is giving one of his first interviews as an MP to GPonline in the bustling cafeteria of Portcullis House. An end-of-term mood is in the air, a sense of relief, as MPs prepare to return to their constituencies for the summer after another momentous few months in British politics.

Read more: Labour GP/MP opposes list closure plan

On top of his constituency work, Dr Williams will spend the summer working his notice at his practice and at the Hartlepool and Stockton Health GP federation where he is CEO.

While he plans to continue working enough GP sessions to keep his licence, and will bring his experience to the House of Commons health select committee - the second post he has been elected to - Dr Williams doesn’t want to be a ‘voice for GPs’.

‘I'll be a passionate advocate of prevention and primary care,' he says, although his job is to be a voice for his constituents, even if that means challenging GP services on their behalf.

In his maiden speech in the Commons Dr Williams called for a greater focus on prevention in the NHS. The former public health doctor says Labour’s election pledge to invest more in preventive health, including more health visitors and school nurses, is among the party’s most important health policies.

Labour, he says, must not be ‘small c’ conservative about the NHS - it must recognise that the service needs to evolve. It should become a more holistic system which considers’ people’s ‘social health’ as well as their physical and mental health. That transformation, he believes, is more than just integrating health and social care.

Accountable care organisations

Dr Williams would ‘love to see’ an accountable care system in the NHS led by primary care and public health - the people who best understand population health.

The current direction of policy, he says, is broadly correct for both patients and the NHS workforce: scaling up primary care, integration with secondary, mental health and social care, moves towards accountable care systems, and attempts to counter the fragmentation of the 2012 Health and Social Care Act and end the internal market.

But that policy direction, he argues, is ‘coming in spite of what the government is doing, not because of it’, with ‘constant tension’ between NHS England and the DH.

His fear is that elements within the Conservative government are allowing NHS England’s transformations to make it easier to open the service up to big private healthcare. The next step, he fears, is STPs partnering with big healthcare companies. ‘That is a threat to our universal coverage, free-at-the-point-of-need model.’

Conservative policy-makers, he believes, are motivated by further marketisation of health. But he says markets do not work; they incentivise expensive, complex activity rather than the kind of preventative measures required.

Preventive care

He adds: ‘Sometimes you need to be able to help people to prevent mental health problems, not by providing more psychiatrists but by investing in community projects that combat loneliness. Sometimes you want to help an older person have enough money to heat their house rather than waiting for them to get pneumonia and ending up in an intensive care bed.’

Before the election Labour leader Jeremy Corbyn said a Labour government would renationalise the NHS, raising questions for GPs about their status as independent contractors. Dr Williams is clear - he supports a move away from the partnership model to a system of general practice provided at-scale by GP-led not-for-profit provider organisations, employing salaried doctors and staff. ‘I don't think it'll be long before we call time on [the partnership] model,' he says. ‘Not least for resilience of primary care.'

He rejects the idea that a salaried service would be less productive. Hospital consultants, he says, are ‘extremely productive’ and productivity is as much about leadership as it is about ‘the ability to make money’.

While he admits GPs will have to ‘cede a bit of control’, he says: 'What you'll get in return is the ability to take holidays when you want to, you'll get the ability to do the bits of the job that you like and that you enjoy and that you're best at.'

But the ‘elephant in the room’, the MP says, is the disparity in GPs’ incomes. ‘Some GPs probably earn twice as much as others and the idea of of all having to pool it is quite threatening.'

New GP model

That is why he envisions an evolutionary transition to the new model of general practice.

The former CCG leader and federation chief executive is a supporter of what he says is the ‘liberal’ approach of NHS England. Its leaders are ‘enabling’ general practice with its various funding and policy levers, to make the transformation he believes is best for GPs and patients.

‘We're in a period of time at the moment - a window that might only be for a couple of years - where NHS England is saying that if general practice wants to be the leader and wants to take that route, then it can do it by itself without something being imposed on it.’

But, he warns, if the profession is ‘foolish’ enough not to ‘get our act together’ and take advantage of that opportunity, ‘the chances are that acute trusts will move into that leadership space'. He adds: 'And then we may all end up working for acute trusts.'

As a GP, he adds, he wants the profession at the forefront of leading the transformation and the new model rather than being led by somebody else.

Dr Williams rejects idea that the £2.4bn package of support in the GP Forward View should be used to ‘conserve’ existing models. That money must be tied by commissioners to transformation. ‘There isn’t a lot wrong’ with the GP Forward View, he says, despite recognising that the money hasn’t necessarily been delivered to the bits of the services that GPs had hoped. He rejects the proposals being balloted on by the BMA for co-ordinated list closure - a form of industrial action in response to what LMCs say is the failure of the GP Forward View.

The money in the Forward View, he argues, must be used to ‘prepare general practice for the future’, investing in at-scale provision. ‘It should be really encouraging practices to collaborate.'

In his own area of Hartlepool and Stockton where he leads the federation, all the Forward View resilience money has been spent on ‘conversations and plans’ to bring practices together, so in one case where three practices share a building, their reception and administrative teams can be integrated.

While practices on a knife-edge, in danger of collapse, must be given immediate support to survive, says Dr Williams, that support must be attached to changes to create at-scale provision.

There will always be some resistance to change, Dr Williams says, particularly from those GPs who believe they are doing well under the existing order. Some will only recognise the need for changes once they face crisis.

‘If there's one thing that I've learned about working with GPs,' he says, ‘it is you can't please everybody. You have to listen to everybody but you have to take a position. And there will always be quite a lot of GPs that don't like that position, because by our nature, we're proud, autonomous people. But ultimately I think if we stay the same it will be unsustainable.’

The goal of transformation, he adds, must be healthier patients and a happier workforce. ‘And sometimes happiness isn't isn't just about making more money. What I hear all the time from GPs is that the currency of time is more valuable than the currency of money. They're looking for things that will buy them the chance to get home at half past six in order to read their kids a bedtime story, rather than having to stay until seven o'clock. And they would definitely accept earning a little bit less money for the chance to get home and read their kids a bedtime story.’

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