The concept of independent contractors in general practice will become “anachronistic” and “probably will have gone” within ten years, according to one of NHS England’s most senior GP leaders.

Deputy medical director Mike Bewick also called for primary care providers to grow to cover populations of around 300,000 and merge with organisations in other sectors.

He said today: “In ten years’ time the term independent contractor will be anachronistic, and probably will have gone.”

Dr Bewick pointed out that a growing number of doctors in primary care at present were salaried, rather than being partners, who own a stake in their practice.

The former GP, who worked in Cumbria for more than 20 years, said: “There will be a… move away from a partnership type organisation because it will not serve them.” He previously worked as a GP in Cumbria for more than 20 years.

Dr Bewick’s comments, at a Westminster Health Forum event in London, come amid growing warnings from primary care leaders of a workforce crisis, and in particular of many practices struggling to recruit partners.

He said current organisational structures were “neither sustainable nor desirable” and that “we’ll have to think of something different”.

Dr Bewick also said that, for primary care to work effectively, provider organisations needed to cover six figure populations “not too dissimilar to” clinical commissioning groups. He suggested the right population could be around 300,000.

“I don’t think we should confuse that as [involving] not delivering healthcare by people you know in your locality,” he said. “But we should be forming organisational mergers with either community trusts, secondary care and other providers or people from other sectors.”

At present the vast majority of GP providers serve populations of fewer than 20,000. Only three have populations of more than 100,000, according to HSJ research earlier this year. However, there has been development of federations of GPs in many areas over the past year.

NHS England called for GP practices to “work at greater scale” in planning guidance last year. National officials and experts have called for practices to work more closely together, for example forming or single organisations or federations, and extending the services they provide.

An “NHS Five Year Forward View” to be published by NHS England next month is expected to include details on provider models suited to reforming out of hospital services.

 

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