Adam Staten is a GP trainee in Surrey and is on Twitter @adamstaten.
In the June issue of the BJGP there was a debate as to whether GPs should maintain their status as independent contractors. To me this seemed like a macrocosm of the decision that all newly qualified GPs have to make when it comes to finding a job.
Since the new contract for general practice it seems to have become the norm for a new GP to take a salaried job which provides stable employment and predictable pay without the burden of extra responsibilities born by partners. Generally this is considered a stepping stone to partnership.
But the status quo is being upset by the increasing popularity of locuming. Dr Larry Locum seems to be the man who has his cake but eats yours. Advocates of this way of working describe it as a Nirvana of convenient working hours, minimal responsibility and good pay. The appeal is obvious and, as the pay for salaried roles gets squeezed, the appeal is growing. Although this life has potential to be unstable many of my cohort feel that this is more than offset by the flexibility and the remuneration.
Whilst many still see a period of doing locums as a prelude to seeking permanent employment there is a growing number of GPs who feel no compulsion to take either a salaried role or a partnership after years of enjoying locum life. Interestingly, medical chambers are also filling up with GPs who have been partners but now wish to locum.
Could this way of working pose an existential threat to the partnership model?
Without wishing to sound mercenary, a big part of the problem is pay and, in particular, the complexity and opaqueness of partner pay. Ask a salaried doctor how much they get paid and they can tell you their pay per session. Ask a locum and they can tell you the going rate. But ask a partner and their eyes glaze over and they start talking in tongues, using phrases like ‘notional rent’, ‘local enhanced services’ and, of course, the ‘QOF’. Meeting the shifting targets of the QOF alone seems as fiendish as a battle of wits with Professor Moriarty. This complexity, combined with the fact that partners often seem to work harder and bear more responsibility than their colleagues, makes partnership seem daunting and uncertain.
Clearly there are less tangible rewards in partnership. People talk of the ability to guide your practice in the direction you wish it to go, or the emotional satisfaction of nurturing your own business but, to the uninitiated, these rewards can seem fairly trifling compared to the possibility of losing your house if things go really wrong.
Compared to becoming a locum, where the pay can be closer to that of a partner, becoming a salaried GP is increasingly seen as an under rewarded role and yet it is still the predominant job type on offer in the jobs market. Whilst many practices seek to employ salaried doctors the logical choice from the perspective of a GP registrar is between seeking one of the few available partnerships or doing locums, or at least having time free in the week in which to do locums on top of a part-time salaried role.
This tension between the demands of new GPs and the supply from practices is in danger of making the locum role the norm with the attendant possibility of sleep walking the partnership model of general practice out of existence. Without partnerships the debate over the independent contractor status of GPs will be moot, it will simply cease to exist.