The small business model of general practice in the UK has “served its time” and should be remoulded, with primary, secondary and community care integrated in single local organisations, the outgoing chairwoman of the Royal College of General Practitioners has said.
In a recent interview Dr Clare Gerada questioned whether GPs’ independent contractor status was still fit for purpose and challenged the profession to adapt to new ways of working. She called for GPs to lead multidisciplinary teams that incorporate acute, mental health, community health, and social care services in the community with all staff employed by the NHS.
The independent contractor status status served us well, she stated, but since 1948 what hasn’t changed is the way general practice is organised and hospitals are organised. “We need to protect what is best about generalism but move closer to our hospital and community colleagues so that we become one organisation and one service. I would challenge whether we need the independent contractor status. I would question whether it actually means anything anymore when we’re actually salaried to the State anyway.”
Dr Gerada called for the model proposed by the former health minister, Ara Darzi, which proposed the historical separation between primary and secondary care to be broken down, to be revisited.
BMJ 2013; 347:f5922
Integration of primary, secondary and community care is an important goal which is long overdue. However, one has to ask whether general practitioners becoming salaried employees is the only way to achieve this. As someone who was a salaried employee of the NHS for the whole of my career I used to think that the independent contractor status of general practice was an outdated model which owed its continued existence purely to political expediency; and that a salaried service would be much more appropriate. Now I am not so sure. The salaried nature of much of the public sector including the NHS has resulted in a grossly inefficient use of resources and to a remarkable lack of innovation. The small business entrepreneurial model can, I believe, deliver a more efficient and creative service. Perhaps the way forward requires a middle way involving salaried staff including general practitioners working for a social enterprise or cooperative independent organisation contracted to deliver comprehensive health and social care to a defined population.