Behind the headlines: Would bringing GPs ‘into the fold’ really complete the NHS?

Rhiannon Jenkins scrutinises an opinion piece in the Financial Times by former health minister Lord Ara Darzi

In a recent opinion piece in the Financial Times, Lord Ara Darzi proposes that primary care should be ‘part of, not arm’s length from, the rest of the health service’. Does this sound familiar? 

During his time as health minister in 2008, Lord Darzi conceived the idea of a national network of polyclinics, commonly referred to as ‘Darzi centres’. These polyclinics were so-called super-surgeries that brought GPs and specialist services under one roof, with the aim of improving access to primary care. 

Although the polyclinics proved unpopular and were quietly withdrawn after failing to deliver value for money, Lord Darzi has popped up again with another attempt to influence primary care reform. This time his proposal is that the independent contractor model should be phased out in favour of a salaried service. 

Here, we give our take on Lord Darzi’s one-size-fits-all plan for general practice.

‘The independent contractor model is “frozen in time” and “cannot keep up with today’s demands”‘

It is certainly true that GPs are struggling to ‘keep up with today’s demands’. But this has little to do with the model under which they work. Rather, general practice is on its knees because it is overstretched and chronically underfunded. Despite long being lauded as the bedrock of the NHS – dealing with around 90% of patient contacts for less than 10% of the national budget – the unrelenting pressure is pushing GPs all over the country to leave for greener pastures. 

Lord Darzi does acknowledge this pressure and its catastrophic impact; he says that GPs have to ‘run ever harder to keep up with demand’ without ‘the best new interventions at their fingertips’, which results in ‘burnout, chronic stress, and mental illness’. 

But ultimately, whatever the employment model, practices need their workload pressure eased as a matter of urgency. Instead of expecting GPs to ‘run ever harder’, make the demand more manageable. 

‘Keeping GPs separate from the rest of the NHS is an impediment to reorganising care’

One of the independent contractor model’s unique features is that it allows GPs to build strong relationships with patients over time. This continuity of care is crucial for the wider system as it is cost effective and improves health outcomes. However, NHS employment would likely lead to the loss of these relationships, as well as the degree of freedom practices have to innovate and adapt services to suit their own patient populations. 

It is also, to say the least, a stretch to suggest GPs are ‘separate’ from the rest of the NHS. They carry out the overwhelming majority of NHS activity, and they remain patients’ advocates.  

And this collaboration is a two-way process. GPs have long raised concerns about the increasing workload dump from secondary care – something NHS England and ministers have promised to address, without GPs seeing much positive change. 

‘GPs should be ‘welcomed on the same terms as those working in hospitals’

Lord Darzi is trying to convince GPs to join the NHS as salaried GPs by promoting the employment terms of those working in hospitals, but he offers no real reason why they would want this. 

Despite the bureaucracy and responsibility that come with running a practice, many GP partners cherish their independence. In principle, they can run their practices as they wish, choosing their own premises and employees – although in practice recruitment and funding problems are barriers to this. By resourcing practices better, the Government would also be able to ensure salaried GPs and other staff have better terms and conditions. 

And a glance at secondary care would suggest the employment conditions are not something to covet. In the past year, nurses and junior doctors have taken industrial action over low pay – one of the factors fuelling chronic understaffing. It seems healthcare workers are dissatisfied with their working conditions no matter which sector they work in. A possible attraction for GPs might be that becoming NHS employees could allow them to take to the streets alongside NHS colleagues.

Lord Darzi’s proposals for general practice show a lack of understanding of the profession, and if his polyclinics are anything to go by, these latest ideas won’t instil much confidence. After all, he is a surgeon and not a GP. 

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