Why I’m not a businessman

In reply to Dirk Vinegar on the Guardian, who says “It is often forgotten that GPs are not salaried NHS clones, but independent business people, most of whom happen to be contracted to the NHS for the main source of their income.”

This is important to get right, because the Health Bill will make it easier for companies wanting to provide primary care services to bid and compete. We have recently seen providers back out of the primary care market.

I’m a GP partner. The reasons why I don’t see myself as a businessman are these:

1) There is no  marketing or advertising. Practices inform what we do, but we don’t make effort to lure patients from other practices. Businessmen would be actively recruiting (preferably healthier, wealthier) people to their lists.

2) There is no attempt to make our workload lighter. Patients who need a lot of appointments, who need a lot of house calls, or who take up a lot of administrative time are not discriminated against. Were I in business, I’d be looking at ways of removing this ‘workload’ (of course, we don’t.)

3) If I was a business, I’d work on attracting people who didn’t have much wrong with them, and encourage them into having tests that they didn’t need. So, for example, regular multiple blood test and physical examinations for ‘MOT’ check ups and other assorted non evidence based nonsense; this would attract customers, we could charge extra as it was non-NHS, and we could advertise our additional services.

I don’t offer this, because it’s not backed up by evidence, and can do real harm. But – ha – it’s a great ‘business opportunity’. It’s also not good medicine.

4) I see patients, front line. If we wanted to make profit first, it would be better to put someone who wasn’t a GP in the front line. Or pay someone less to do my job, or bits of my job. And let me concentrate on management.

But I’ve been trained to do this job, so it’s me seeing patients, not accounts balance sheets.

In honestly, I think I’d prefer to be on a national salaried contract, with no more daft boxticking as  the GP contract dictates. I am not sure what we’d have to replace it – given that professionalism seems hardly trusted by politicians. Yet patients generally do trust doctors – and peer review is a very useful and underused tool.  I can’t help but think there is a better way to pay GPs – not as businessmen but professionals.


4 Responses to “Why I’m not a businessman”

  1. michael February 14, 2012 at 8:01 pm #

    Margaret, the reason you are not a businessman is that you haven’t got enough Y chromosomes.

    (Sorry, couldn’t resist the temptation to wind you up)

  2. steve February 14, 2012 at 8:12 pm #

    “In honestly, I think I’d prefer to be on a national salaried contract”

    Be careful what you wish for Margaret – I know plenty of salaried GPs and PMS docs who wish they weren’t. Indeed, two salaried docs in my part of the world have recently been made redundant.

    In other respects you, me and every other GP partner is a business person. We employ people. We provide non-NHS services for which we charge a professional fee at a professional rate. Some of us (not me) are VAT registered. Some of us (again, not me) work in urban areas where we do, inadvertently, “poach” patients by being better than others. When it comes to our accounts we apply for car mileage allowances, etc. And, in the end of the day, we are in the business of making a profit so we can pay ourselves an income.
    Being a GP partner carries with it a huge burden of responsibility that goes beyond seeing patients. If all a doctor wants to do is work fixed hours/days and see patients and not worry about profits and losses, health and safety, employment laws, etc. then they should forego partnership (and the benefits that go with it) and become salaried docs.

  3. Margaret McCartney
    margaretmccartney February 14, 2012 at 11:53 pm #

    well Steve
    I wouldn’t want the current salaried model which I think is often exploitative. Instead I’d compare more to hospital consultants, who have (at least in Scotland) more room to use professional peer review, and whose consultations aren’t bound up with the latest QOF nonsense. Professional development could be simply part of our job, and we could use professional skill rather than contract tickboxes in our day to day work.
    The reasons I have listed for not being a businessman are reasons which would be ignored if private providers were to run GP surgeries. This is what worries me.

  4. Sam Barnett-Cormack February 22, 2012 at 12:05 pm #

    I think stating outright that NHS GP practices are private businesses is disingenuous. They have restrictions on their conduct that no private business would generally have, and they way they conduct themselves is not, as Margaret describes, entirely comparable with business practices. The basic legal identity is there, as Steve suggests, but in a huge number of practical ways GPs simply aren’t business people, and practices are not businesses.