Twice recently I have opened HSJ with particular interest as a GP and turned to articles on salaried general practice ('Cheque it out', 22 July; 'Income outcome', 5 August). But I have found them to be shallow in their approach.

There is no doubt that GPs' aspirations and career patterns in the future will be very different. For many, a salaried post with terms of service including defined hours and a contract of employment is attractive.

A hidden agenda is avoiding all work in unsociable hours and assigning to others responsibility for providing cover for absence. The managerial mind also sees this as a tidy solution to some of the ever-present anxieties and inconsistencies of practices.

Almost nothing I have read has dealt with the major issues of premises and the rest of the ever-increasing complex infrastructure of current practices. The British Medical Association estimates traditional GPs' average current personal investment in premises alone is£100,000. Many existing principals have major difficulties over negative equity and are not at all sure of making any profit from their investment in premises. Unless they stay in the same place for at least 15 years, covering their costs is difficult.

While there is a profusion of managers and staff in practices, most principals undertake a wide range of duties in organising their practices. Any sensible discussion of a salaried general practice has to include realistic costing and arrangements for these aspects. It is hoped that the analyses of current primary medical services schemes will be comprehensive enough to cover this. It will be interesting to discover whether this will be different from the amount in the doctors' and dentists' review body report, which separates the GPs' target net from target gross pay.

Dr Malcolm Fox

South Park Surgery


While thoroughly agreeing with Steve Ainsworth's sentiments ('Yorkshire Terrier', pages 16-17, 12 August) that a salaried GP scheme is doomed to failure, I was amused by the idea of GPs picking up a light bulb on their rounds, or personally arranging a locum if they go sick. What does he think GPs employ practice managers for? We fit in these little chores along with the accounts, salaries, estate management, staff appraisals and appointments, chairing meetings, maintaining the computer systems and generally ensuring that all GPs have to do is hold surgeries and do their paperwork.

Roz Foad

Deputy practice manager

Red House Surgery