Letters: Skill mix and the benefit of a salaried profession

I was interested in the article 'Job crisis is "bigger threat" than private firms' (GP, 21 November). The job crisis is, indeed, worse than the threat of private firms.

I moved six years ago from Bristol, where I was a partner, expecting to get a partnership after some struggle - some struggle it has been.

Certainly, this crisis isn't confined to younger GPs. There is a sizeable minority of middle-aged, experienced GPs who cannot get into partnerships.

The reason? Mostly partners and partly the government.

What has happened is that there is a growing underclass of non-principal GPs and practice nurses who bolster the falling wages of partners.

Of the few partnerships that come up locally, most are filled in-house or by word of mouth. Very few are advertised.

Partners see that it's more work-efficient and cost-efficient to employ nurse practitioners and non-principals but I wonder whether they have thought through the consequences for many highly trained, motivated non-principals?

At the moment there is a surprising lack of debate or complaint about this issue.

But it suits the government too - it must be aiming to usher in a new salaried profession. Again, there is no debate about this: when sufficient numbers of us non-principals exist, the logic for a salaried profession will too.

But it's odd that none of us GPs are talking about the possible benefits. No mention is made of the fact that hospital doctors manage in a salaried role without their integrity being compromised.

We could be freed from the business aspect of general practice for which there is no training in medical school and which detracts from patient care.

We could be more honest as a profession - few patients realise that GP surgeries are run as businesses for the profit of the partners. Maybe that's why GP principals are kicking up a fuss?

At 48, I've just managed to get another salaried post locally. I'm not bitter - I'm sure I would have behaved similarly to most principals. But I am perturbed that the truth is not reaching the light of day and perplexed that so few of us are commenting on this worrying trend.

I shouldn't be bitter, it was essentially my fault that I couldn't get a partnership, market forces operated so I should improve my saleability and, what do you expect living in Gloucestershire?

Dr Hugh van't Hoff, Dursley, Gloucestershire.

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