Time to tailor general practice to fit diversity

General practice is no longer a one-size fits all profession. It may have been the case at the founding of the NHS, when the majority of GPs were male partners and full-time in the fullest meaning of the term.

Now we have a profession that is close to 50 per cent female, where out-of-hours is no longer necessarily part of the job, part-time working common and partnerships are no longer the lot of every doctor choosing primary care.

The GP career path is not just a case of finding a practice to buy into. Fewer partners are necessary under new GMS because funding goes to the practice not the individual partners, which means fewer partnership opportunities (GP, 21 March) - always assuming the young GP can raise the necessary funds in the first place.

The nature of being a GP has changed but the ways that GPs are represented has not kept up. Or so a report from Londonwide LMCs, Leading with Diversity, would suggest.

'Employed GPs', and for that matter female GPs, are heavily under-represented among LMC seats in London despite making up half the workforce in some parts of the capital.

At the same time, the report finds that employed GPs feel they are being exploited by practices, underpaid and left without proper employment terms and conditions.

But because LMCs are seen as the preserve of the partner, salaried GPs feel they have nowhere to turn. The report's authors warn this could lead to the profession being torn apart.

This situation needs to be tackled on a number of fronts. There is the issue of a career path for GPs that has been discussed in this column more than once.

But perhaps more urgent is the financial gulf that seems to be developing between partners and salaried GPs. A rebalancing of the job market may be required if these doctors are to be retained. Partnerships will not be able to make money from the quality framework or enhanced services if they are under-staffed.

Finally there is the issue of representation. If LMCs are seen as 'gentlemen's clubs' for partners, as reported, then employed GPs will continue to feel alienated and look elsewhere for a voice. This will widen the gulf further. And where will these salaried GPs seek this voice? Will it be through creating a new section of the BMA or will they become more unionised by forming their own body or even turning to an organisation such as Unison?

At GP we are talking about the importance of valuing general practice - that means valuing the whole profession, not just those who have a voice thanks to tradition. Without this change, future general practice could be fatally undermined.

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