Ever since the NHS was created in 1948, GP services have remained privately run. They are typically partnerships of General Practitioners who employ a Practice Manager to look after the smooth running of the admin. The virtue of the model is that doctors themselves are in charge and, despite (in England) the deluge of diktats from their local Integrated Care Board and from NHS England, they feel empowered by the fact that they decide how their practice is run.
Now Keir Starmer has floated the idea of taking away their clinical leadership and turning them into paid employees of the NHS. Instead of the administration reporting to them, they’ll report to the administration. Supposedly, this move will allow “GPs to focus on caring for patients rather than the admin that comes with effectively running a small business” and work “much more closely with other parts of the system”.
Mr Starmer points out that many GPs already are salaried rather than acting as partners. Of course different GPs have different preferences. Some like to act as locums receiving a day rate. Some are keener on a salary than a partnership. But the beauty of the existing system is that it allows GPs to choose what sort of career they want. Nationalising GP practices would narrow those options and, ultimately, make GP careers a less attractive option.
There are two problems with NHS GP services right now. The first is that there is a shortage of doctors. There is a perception that, in the golden age, GPs were highly responsive and worked hard, and that now they’re all part-time and won’t lift a finger. In fact, the average GP is working 38.4 hours – a full-time job – even though in the way the NHS counts it they are only officially working part-time. Regardless, it's hard to see that making GPs employees would encourage more hours to be worked.
So why are there too few doctors? Well, it’s because, in our state-controlled system, the government artificially caps the number of medical students. Farcically, a new medical school at the University of Worcester isn’t allowed to take any English students because of the limit. Simon Trickett, who leads the local NHS commissioners in Herefordshire and Worcestershire, expects to spend over £70 million in locum and agency staff because of the shortage of doctors. He told The Observer: “It is really frustrating. The local system is 100% behind this medical school. The GP surgeries, the hospitals, the community services and the local councils all really want it. But it is being blocked from entering the market.”
The second problem with NHS GP services is that the incentives are set wrongly. GP practices are paid principally on the number of patients they have in their database, and not for actually seeing a patient. Is it any surprise, then, when patients of some practices find it difficult to get an appointment?