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.