Exclusive Almost 40% of GP partners across the UK would consider becoming salaried ‘if they were offered the right deal’, a Pulse survey has revealed.
GPs told Pulse that lack of core contract funding, and uncertainty around the national insurance contributions hikes more recently, are contributing to partners considering going salaried.
The recent survey results, which had responses from over 400 UK GP partners, showed that 38% responded ‘yes’ when asked if they would consider going salaried if offered an adequate deal by the Government, with 13% saying they did not know at this point in time.
However, almost half (49%) of respondents said they would not consider it, citing the importance of protecting the independent contractor model as it ‘provides the best care for patients’.
Wiltshire GP partner Dr Nick Brown, who has been a GP for 30 years, told Pulse that that he changed his mind ‘very recently’ about considering going salaried, because the benefits of being self-employed are being ‘completely undermined’ by lack of funding.
He said: ‘I’ve been looking at our practice accounts, and we are earning less than we did 11 years ago as partners. So in other words, we are subsidising the NHS.
‘We’re self-employed with a contract that doesn’t allow us expand our practices and we are completely trapped.
‘Being self-employed, we can’t do what we need to do, and we’d be better off actually just working to rule, doing what we get paid to do, rather than trying to run our practices on not enough money.
‘People can’t see the attraction of being self-employed anymore in the current situation. A lot of people coming into general practice are not interested in that. They don’t want the sort of commitment and responsibility that we all join general practice for, 20 or 30 years ago.’
Dr Brown also mentioned that the national insurance changes announced in the Budget will cost his practice £70,000.
He said: ‘That is 10% of our current profit so that is completely unsustainable, it will kill us off to be honest.
‘If we were salaried, we wound not have to worry about any of this, we wouldn’t have to decide what to do about it, because it wouldn’t be our problem.’
Dr Andrew Dunlop, a GP partner in West Lothian, said he would be in favour of GPs having the same contract terms as secondary care consultants.
He told Pulse: ‘My perception is that most junior colleagues, given the choice between a contract equivalent to secondary care and being self-employed, they’d choose the former over running what is essentially a small business.
‘Looking more recently at the issues regarding national insurance increases, they have only emphasised the limited scope there is for any realistic increase in income generation for GPs.
‘What has happened has highlighted that if you’re running a business as an independent contractor, essentially your opportunities to diversify are extremely limited.’
Gloucestershire GP partner Dr Charles Inman said that many partners ‘have had enough’ and that ‘there is a temptation to give in’.
He told Pulse: ‘It would all be much easier. Less risk for us personally and being salaried would mean GPs working to their contracts and so a lot of the work we do out of good will and dedication to our patients would need more salaried GP numbers to cope with.
‘We are doing significantly over and above in our practices, out of dedication and good will. We are on the brink of not being able to continue because funding is squeezed so tightly. The latest national insurance and minimum wage increases are the last straw.’
A Yorkshire GP, who asked to remain anonymous, told Pulse: ‘I would consider going salaried if it was an attractive and significant buyout deal offered by the Government, with good and clear salaried terms with recognition of experience and years of service.’
When asked to respond to Pulse’s survey findings, a Department of Health and Social Care spokesperson said: ‘We want to work with GPs to fix the front door of our health service to ensure everyone can access GP services. We’ve started hiring 1,000 extra GPs and cutting red tape so they can focus on treating patients.
‘We are committed to the investment and reform of general practice and through our 10 Year Health Plan, we will shift care out of hospitals and into the community to build a sustainable health service fit for the future.
‘The employer national insurance rise will not begin until April, and we will set out further details on allocation of funding for next year in due course.’
Earlier last year, NHS England’s national director of primary care said that ‘hardly anybody’ qualifying as a GP this year wants to be a partner and that general practice ‘needs to evolve’ to ‘make sure it is attractive for a new generation of clinicians’.
Health secretary Wes Streeting has previously said that he now recognises the ‘value GP partners provide’, following his comments about Labour wanting to ‘tear up’ the ‘murky, opaque’ GP contract, while considering abolishing the GP partnership model in favour of a salaried service.
He said he remained ‘open minded’ about the future of the GP partnership model, seemingly rowing back on those comments earlier in the year.
A previous Pulse survey also found that high workloads and administrative burdens were cited among those who said they would think about becoming salaried under certain circumstances.
And a report from the Institute for Public Policy Research concluded that all new GPs should be offered salaried employment as ‘primary care consultants’ with pay in line with hospital consultants.
The results in full
Would you consider becoming a salaried GP if offered the right deal?
38% – yes
49% – no
13% – don’t know
This survey was open between 19 September and 18 October 2024, collating responses using the SurveyMonkey tool. A total of 426 GP partners from across the UK responded to these questions. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £200 John Lewis voucher as an incentive to complete the survey. The survey was unweighted, and we do not claim this to be scientific – only a snapshot of the GP population.
Source: Pulse survey
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READERS' COMMENTS [9]
Please note, only GPs are permitted to add comments to articles
It would sad to loose independence contractor status but if we want it as our business then we need proper funding to take over OOH service. It will improve services to patients and reduce a and e attendances.
If this is based on income this survey makes no sense – the average income for full time GP partners in UK 2022/23 was £140,200, for full time salaried GPs their average income was only £69,200. Can 40% of GP partners really cope with a £70,000 pay cut to become salaried?
Average income for a partner is not 140k it is more like 100k ( after the employers SA is paid to help with comparison). If they went salaried it would be with an agreement that put GPs pay on a par with consultants. It would also then free you up to provide private work to any patient who wanted it just like consultants. This puts you in a more powerful position to decouple from the NHS if the start playing silly buggers with your contract. It would remove all the vicarious risks. It is a no brainer when compared to being so called self employed with just one very very restrictive contract with the NHS and no rights to do private work within your own community.
I have always believed the partnership model will constantly be better for patients and more cost effective but would accept a salaried model if enforced. That would be the end of decades of minimal sick leave as with most partners and other professional colleagues and having to turn up to keep the practice going when clearly many, under the ‘Agenda for Change’ or other contractual arrangements would not and have not arrived for work( quite rightly generally) in similar circumstances.
The costs for the NHS will spiral, and most partners can foresee this due to loss of multiple efficiencies. However, we now have the situation with layer after layer of below average NHS managers in their tens of thousands who overshadow those smaller group of highly performing managers with health-related knowledge and real business insight.
These genuinely excellent managers are a minority as opposed to many NHS managers whether clinical or not, who are more correctly termed admin staff but have assumed the title ‘manager’ or ‘NHS director’ in the unaccountable NHS management haven, at whatever level within the NHS and particularly within NHS England who are not in many cases and in any sense management level quality but simply ‘Chart Gazers’ and ‘email influencers’ with no substance .
The ‘Chart Gazers’ in their relentless drive to point out downward lines on their multi coloured beautifully laid out patterns, week after week, occupying no doubt hours of NHS time and pointing inevitably to the downward negative aspects missing the point about a minimally funded Primary Care Service having survived their own unaccountable NHS management ineptitude. They are additionally supported by layers of frontline avoiding ‘Criticiser Groups’ whether the multiple so called costly and ineffective ICB Oversight teams, CQC, NHS England, GMC or others.
Thousands of unnecessary managers, many never having ever worked in a GP practice advising us all on how to manage patient care in a service they have themselves systematically destroyed, buoyed by those sycophantic groups such as the RCGP who continue to take vast yearly fees with the main aim of achieving their own Royal accolades or titles rather than any real genuine support over decades for General Practice in my view.
Opinions differ, but in my estimation , the BMA is not perfect like anyone of us but is continuing to doggedly fight the corner of general practice and deserves recognition for this.
However, it will be a losing battle in my view unless the current principal vehicle of destruction of Primary care is stopped i.e. PCNs via their own admin level staff paid at GP rates i.e. PCN CDs.
How is it, that an admin role such as PCN CD, led largely by the very small, self-selected group who normally find themselves out of the GP practice in multiple PCN, ICB lead. LMC, NHSE etc roles combined with ICB implementation managers many of whom, have as above, never seen the inside of a GP practice are now advising those who continue to work within and maintain Primary Care as a going concern despite their incessant unwarranted and proven ineffective destructive interference?
You are mistaken Mark, both figures are directly comparable in that they include employees pension contributions but exclude employers contributions – I got my figures from NHS England Digital (the same source that Pulse use) and I quote from NHS digital’s website: “Superannuation contributions
The results for contractor GPs exclude an estimate of employers’ superannuation contributions, but are before the deduction of employees’ contributions.
The results for salaried GPs include an estimate of employees’ superannuation contributions and Additional Voluntary Contributions (AVCs). This puts the salaried results on a comparable basis with the contractor results and allows results for combined GPs to be produced for the report.” That’s why the figure of 38% willing to drop £70,000 a year is so surprising – given that 50% of full time GP partners are earning over the £142,000. The government needs to be aware of just how broken General Practice has become under 14 years of Tory destruction and belittling of General Practice leading to the current retention and recruitment crisis. BMA survey’s these days seem to always point out that rank and file GPs aren’t that bothered about money its more about their unsustainable workloads that leads them to retire early or go part time.
Nigel, I’d be surprised with those figures above given most salaried sessional rates are 11500-12000 per session per annum now.
69200 must then be for 6 sessions. Is this compared to 8-9 session partners?
Per the BMA a full time salaried GP is 9 sessions- a 9 session salaried GP would be earning 104-108k .
Aside from that, the article didn’t mention GP partners throwing it in for the existing salaried contract, but parity to secondary care consultant contracts.
It is interesting to consider who is pushing this, what ‘the right deal’ would look like, and what the consequences would be.
I think it is being pushed by secondary-care focussed senior NHSE leadership, and possibly some hospital CEOs. I think they see greater control over the whoel system as being part of the solution to their problems. It would certainly make their life quieter if they didn’t have to deal with pushback, and everybody adopted their worldview. The problem is, of course, that in its independent contractor model it is highly effective, efficient, and popular; and what would replace it would be none of those things.
What would ‘the right deal’ look like? I think, as a minimum…
– pay parity with consultants, and similar seniority arrangements
– similar working plans to consultants (so, one session of admin time for every patient-facing session, protected learning and teaching time, protected management time etc). this would obviously lead to a huge drop in output and productivity, but that’s part of the price of the loss of our autonomy
– the ability to undertake private practice freely outside of NHS hours, with no restrictions. someone is going to have to see the huge number of patients who can no longer access a GP
– NHSE picks up all staff and estates liabilities, including buying out those partners who own but wish to sell their buildings
I am sure there are others and would very much like to read other views.
The consequences would almost certainly be tolerable for many doctors – NHS income may drop but be replaced by lucrative private work and extra sessional work for the NHS at inflated rates; workload and output would drop significantly and quality of working life safeguarded by BMA-approved job plans; overall stresses would reduce as responsibility for the patient would no longer be ‘ours’ but instead the nebulous system’s (meaning no one,’s really, in the collusion of anonymity that is the modern NHS); similary our responsibility for the safety and effectiveness of the service would disappear, reducing stress further – it might be rubbish, but it would be someone else’s responsibilty to run a safe service on a grossly-underfunded contract.
For the system it would feel like a triumph for about twenty minutes, then it would quickly roll into being an unmitigated disaster, from which the NHS cannot return in a meaningful form.
For the patient, it would be *awful*, obviously.
All good points DT but you missed out one final and very important benefit, that being the ability to go on strike, which would become so much easier as a salaried employee.
You are so correct