RCGP chair questions future of independent contractor status

RCGP chairwoman Professor Clare Gerada has called for a debate on the future of GPs' independent contractor status, warning that the NHS must consider radical solutions to the challenges it faces.

Professor Clare Gerada: debate future of independent contractor status
Professor Clare Gerada: debate future of independent contractor status

Speaking at an RCGP-backed conference on GP federations, Professor Gerada called for a move to single provider organisations that span primary and secondary care.

She said GP federations should merge with parts of secondary care and community trusts to form the new groups. The structure outlined by Professor Gerada appears similar to the US-style 'accountable care organisation' model, identified by NHS England as one the health service could adopt in future.

Professor Gerada told the conference, organised by Newham CCG and the college, that general practice could reshape itself to ‘take us where we would have been had we not had the biggest top-down, nonsense reorganisation’ of NHS services.

Prior to reforms driven by the Health and Social Care Act, she argued, PCTs had been merging, creating large geographical, contiguous populations, and practices were also merging. Merged practices had begun pooling resources with secondary and community care organisations, she said.

‘Surely the way to go forward,' Professor Gerada argued, ‘is merged organisations of providers - new organisations which merge together GP federations, GP networks, with those parts of acute, mental health and community trusts that deliver the care that we want to deliver to our patients.’

Professor Gerada, whose three-year term as RCGP chairwoman ends in November, said the plan could deliver ‘what we all know has to happen, which is the movement of hospital practitioners into more generalist, community roles’. She called for GP-led development of new systems of primary care delivered by multidisciplinary teams.

She called for an end to the development of complex systems by commissioners that meant a phone call to a consultant could cost a £10 tariff.

‘Wouldn’t it be better,' she said, ‘to be looking at a single organisation where we start to deliver those bits of care that patients want and need in the community.’

She also said GPs need to be talking about the future of the independent contractor status. The new generation, she said, did not hold the partnership model to heart in the same way as older generations.

Professor Gerada, who emphasised her ideas were ‘blue-sky thinking’, not college policy, said the proposals would build on RCGP policy on GP federations, the 2022 vision, and the political moves towards integration of care. She said her proposed single provider organisations would also help address the historical division between primary and secondary care, financial restraints, and help to deliver population health at scale.

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