Your headline ‘DoH plans funding cut to limit GP profits’ made me think (GP, 26 January).
If the DoH can really do this, this is a threat to GPs’ independent contractor status. So what is the alternative? Salaried status.
There are lots of salaried doctors in the NHS. They are called seniors and juniors; consultants, hospital practitioners and doctors in training grades to you and me. There is no talk of capping their profits as they don’t have profits, at least not as far as the NHS is concerned.
Perhaps we should join them. Senior GPs, partners in contract with a PCO or equivalent, would become primary care consultants. We would be assisted by juniors in various grades who would do much of the routine NHS work.
We would each be able to agree individual contracts with the employing authority which would allow us dedicated time for administration and CPD plus time off for private work if we chose.
We would no longer have to worry about providing premises or struggle with employment legislation. We would be able to go sick and would have time set aside for holidays and for attending professional meetings and conferences. We might well be able to access funding to attend the latter.
This would of course mean that the provision of primary medical care would be similar to secondary medical care with long patient waits, poor communication and a failure to achieve government targets. To provide anything like the current level of primary care would probably cost about double that currently spent in this way.
The UK gets a good deal from primary care as constituted. GPs work hard and carry considerable professional and financial responsibility. Our patients, despite extensive efforts to blacken our image, still appreciate what we do.
The government is trying to break up the monopoly which it perceives general practice to be. If we don’t play ball, perhaps Boots or some American or European health maintenance organisation (HMO) will bid for our primary care contracts.
It is true that such an organisation might be able to cherry-pick some bits of primary care to run at similar costs and make a profit. It is also true that a large organisation could afford to take a loss for a while in order to put GPs and practices out of business. However, I doubt that a large HMO could run more efficiently.
This is a bluff if the gloves are on and blackmail if they are off. We need to stick together and support our leaders to see the government off.
This government doesn’t understand GPs and general practice. If necessary we can collectively give it a reality check.
Dr Lewis Miller