Liam Cahill The idea of moving to salaried GPs has been floated for some years and it is an interesting debate. An ideal healthcare system will incentivise all working in it to collaborate to deliver appropriate and high quality care at a low cost. The current system of remunerating GPs has some misaligned incentives - eg QoF was poorly designed. However, GPs are generally run as efficient small businesses which treat patients as customers, albeit it is getting much harder to see one. Many GPs are already paid salaries within partner owned practices, but I am sceptical that moving all GPs to a salary will improve the alignment of incentives and ultimately lead to a better system. Doctors in secondary care appear to be mainly salaried, but many earn most of their income from undertaking additional work through agencies, insourcing companies, backlog reporting companies, and or treating NHS and private patients in private hospitals - their productivity during their salaried hours is very low compared to international benchmarks (partly due to poor processes that they work with)
I help NHS orgs embrace digital & innovate ➕ I help healthtech fit the NHS. National advisor. Social enterprise advocate, founder & non-exec. I write about #digitalhealth on LinkedIn.
Super interesting development in the HSJ today. NHS England's clinical lead for emergency medicine Chris Moulton has called for primary care to shift to being salaried. Let me explain why this is interesting, and then why I agree. A few years ago, I heard rumblings from a notable leader that this was being discussed and proposed internally, but not publicly. Clearly the political masters in their true blue ties were not supportive or confident enough to put that into the open domain. However, with the new political master in a red tie having already signalled that he's interested in reforming the GP contract, perhaps it feels more politically safe to advocate for it. Or potentially to start teasing it. Especially since it was aired at the NHS Providers conference. Remember that NHS England is laser focused on controlling the narrative from leaders, and whilst he may be speaking outside of that, it's unlikely given the platform. Now, why do I think this is a good idea (expecting grenades back). The Carr Hill model + QoF model (or what's left of it) + DES model = crap: 1. it disincentivises innovation, and forces prioritisation based on business objectives, which we need to move away from (silo mentality). 2. it forces doctors to prioritise things that aren't care. 3. as we've seen it means that national approaches or budget initiatives screw them over or create mess. 4. it becomes separately lobbied and is too much down to an annual power game which inhibits change. 5. It puts too much pressure on GP partners to get by, or it can occasionally lead to unreasonable role inequality where partner pay is higher than is reasonable. 6. Which forces GPs to have to consider profit vs care objectives. 7. It can lead to General Practice issues not being shared by local systems. All of the above is compounded by the fact that in the pandemic and post pandemic maelstrom PCNs haven't really been fully baked and feel like a constant compromised bolt on between two ideological model. Now expecting some kick back, but I think it's good to see this particular wind shifting and hope that we'll finally see a better discussion about an ideal general practice model. https://lnkd.in/eJ9Mi9gG
Where’s the money coming from to privatise primary care - a magic money tree? Another dumb kite flying exercise which distracts from the real issue which is the utter lack of joined up planning and strategic investment across health and social care. A huge factor impacting on emergency care is the high volume of bed blockers who have nowhere safe to be discharged to.
Interesting
Scott Harwood
4mo
I agree with your comments that GPs run as efficient small businesses, however, their driver is profit and let's be honest some make too much out of the NHS (and some not enough). Some GPs are good at running small businesses and whilst others are not (and/or are happy being a salaried GP). I might disagree with your comment that GPs see us as their customers - I'm not sure I feel like one (more a hinderance sometimes) and their real customers are the NHS commissioners. We do need massive reform of the NHS system - but who's brave enough to do this with all the political risk involved?
Retired Managing Partner and Medical Director
4moBring it on. At last someone is talking sense. The charade of GPs being in the NHS is at last being exposed. The NHS primary care service is largely a conglomeration of self interested franchises that operate under the NHS banner which are run for the convenience and profit of the partners. This step might be the beginning of the move it needs to being a proper joined up service - eventually - that will allow doctors to earn a reasonable salary, deliver better and timeous care and stop the waste of clinicians time on non clinical business administration. More disruptive thinking like this is needed! That said the whole system is broken not just general practice. A recent illness - a chest infection - required the involvement of three services, three phone calls, four interrogations of clinical history, eight HCPs and eight hours to get a prescription for antibiotics. There was a time when one phone call and one HCP could achieve that in a shorter time frame!