In a letter published on Wednesday July 3rd 2016, Mr Hunt asked the Doctors and Dentists Review Body for its “observations” on the factors affecting recruitment, retention and motivation of salaried GPs. The review body’s previous report had an expansion of the salaried model in general practice and the Secretary of State said that “understanding this trend would be important”. GP Online had as its headline on 4th July “Jeremy Hunt asks pay review body to examine salaried GP model”.

Salaried general practice is increasing, within the partnership-based franchise system of general practices, to accommodate part-time doctors and those not yet ready to join partnerships. It may also be a way of increasing partners’ incomes without increasing their workload, but traditionally a salaried option has been very much a minority enthusiasm in general practice.

This seems to be changing. One of the most high profile primary care-led “vanguard” providers is considering whether its GPs should become salaried employees, potentially of an acute trust. Naresh Rati, executive director of Modality, the Sandwell and West Birmingham-based “super partnership”, told the HSJ (July 7th) that its GPs were “not averse” to “moving under an acute trust umbrella” if it aided service integration.

Modality, known until last year as Vitality, is one of the most high profile and widely praised of the national “multispecialty community provider” vanguards. The Five Year Forward View said under the MCP model “larger group practices… could in future begin employing consultants or take them on as partners, bringing in senior nurses, consultant physicians, geriatricians, paediatricians and psychiatrists”. He also said he did not think many GP-led organisations were currently ready to be the lead provider in new care model arrangements.

Comments posted on the HSJ discussion forum were not so enthusiastic about salaried general practice. One anonymous writer said: “Look at acute Trusts that have absorbed community services, and see if they have been treasured and respected or ignored and neglected”.

Another added: “The acute trust model doesn’t create particularly good incentives for its doctors either. Given that the model in most other countries is for specialists to be self-employed, perhaps we should look at a partnership model for specialists, rather than seeking to make GPs employees”.

A named contributor, Andrew Vincent, saw mergers of GPs with acute Trusts as a necessity. “I have been advising Acute Trusts to consider closer integration (with primary care) for some time. However, it is NOT because it would create a more successful model but very specifically because primary care is under so much pressure, in some places in complete meltdown. That becomes the Acute Trust’s problem anyway and so my advice was get ‘stuck in’ before you have to”.