The Institute for Public Policy Research (IPPR) says the historic GP ‘partner model’ should be phased out to tackle the workforce crisis, provide better care and ‘let doctors be doctors’,
The IPPR is calling for GPs to become salaried employees of the NHS, rather than independent contractors, (partners), who run their own GP practices, a move that would overturn the historic model of general practice that has been in place since 1948.
In the report, Realising the neighbourhood NHS: A new deal for primary care in England, the think tank argues for the current model to be phased out in favour of new NHS ‘Neighbourhood Care Providers’ (NCPs).
NCPs would serve communities of between 50,000-100,000 people and join up primary, community and mental health care and give patients access to longer opening hours, diagnostics and treatment in the community. With a wider team of healthcare professionals such as pharmacists and mental health nurses to support the GPs delivery of care.
Under the proposals, senior GPs would be offered management roles within the new NCPs, while newly qualified GPs would be offered salaried roles within these new organisations. This builds on the existing trends, with younger GPs preferring not to become partners and tending to opt for salaried or locum (agency) positions.
The think tank’s researchers argue that this shift would enable the NHS to deliver better access to and quality of primary care in the community while helping to address the workforce crisis in general practice by allowing ‘doctors to be doctors’ and focus on patient care rather than managing ‘businesses and buildings’.
Chris Thomas, IPPR research fellow and report co-author, said: ‘Our approach to general practice hasn’t changed since 1948. Seventy years later, that system is at breaking point.
‘We’ve seen a collapse in recruitment, soaring GP workloads and too few patients receiving the care that’s right for them. It’s bad for patients, and it’s bad for family doctors.
‘There’s an urgent need for a new deal for general practice. At the heart of this must be better pay, conditions, flexibility and work-life balance for hardworking general practitioners. It’s time to let doctors be doctors.’
However, Professor Martin Marshall, chair of the Royal College of GPs, says scrapping the partnership model won’t help meet workforce targets.
‘The College is hugely supportive of the partnership model of general practice, within a mixed and flexible economy of contractual models.
‘It allows GPs to innovate in the best interests of local populations and it provides excellent value for money for the NHS.
‘We are also optimistic about Primary Care Networks, which sound similar to the Neighbourhood Care Providers advocated in this report, and PCNs and the partnership model are not mutually exclusive – it is essential that partnerships work effectively with and within PCNs to deliver high-quality place-based care to patients.
‘However, PCNs need to be given the time, space and support to effectively develop and to build connections within the wider NHS system, in order to deliver place-based care that meets the local needs of their patients.
‘Scrapping the partnership model is certainly not the solution to the pressures facing general practice, improving patient access, or meeting the Government’s target to build the workforce by 6,000 full-time-equivalent GPs.
‘Last year’s independent review into the partnership model clearly stated that it is an important model, and viable career option for GPs at all stages of their careers – but that there are key issues that need addressing, most salient being the need to reduce unnecessary workload in general practice and expand the workforce.
‘The new GP contract is a step in the right direction and financially supports GPs into partnership roles through a new scheme.
‘We also need the forthcoming NHS People Plan to include comprehensive plans on how they plan to train and recruit more GPs and other staff, as well as retain existing GPs in the profession and encourage more GPs into partner roles – and tackling ‘undoable’ workload should be a starting point.
‘On top of this, we need to see continued support for PCNs to be allowed to achieve their potential.’
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