GPs working as independent contractors should be phased out of the NHS over ten years, according to a report by an influential think-tank published today.

The Policy Exchange report was endorsed by Health Secretary Sajid Javid who said it offered “credible ideas.” The researchers said their ideas would help improve recruitment – as data yesterday showed a continued decline in GP numbers. According to the researchers, independent provision would continue to play a central role – but growing numbers of GPs would work for a salary or be employed by providers of primary care services.

They claim their proposals would enable doctor autonomy, innovation and relationships with patients to be maintained.

GP leaders reacted with caution to the proposals, welcoming a focus on reducing the bureaucracy faced by doctors but highlighting the continuing tension between GPs and the government and NHS England. A monthly report from NHS Digital yesterday showed that 91 GPs left the profession in January.

The Policy Exchange report states: “The interface between primary and secondary care, and between general practice, community and social care remains too fragmented. The expert generalism of GPs is valuable and must be deployed more effectively. But rather than operating at the top of their licence, the remit of GPs has become too broad. In the face of pressure, discretionary effort is now demanded of GPs, rather than rewarded. Contracting and reimbursement mechanisms are confusing and dated. Many GP premises are no longer fit for purpose. GPs and their patients deserve better.”

Royal College of GPs chair Professor Martin Marshall said: “The College agrees with Policy Exchange that a comprehensive rescue package is urgently needed for general practice. GPs and our teams are working harder than ever to deliver care and services for patients under intense workload and workforce pressures, which as this report rightly acknowledges, have only been exacerbated by the pandemic. We would advise caution against implementing wholescale changes to the way GP care and services are delivered, and how patients access them, without properly piloting and evaluating such initiatives in terms of efficiency, patient safety and how they impact on the long-standing trusted relationships between family doctors and their patients.

“We would also urge policymakers to recognise that current models of NHS general practice – including the partnership model – delivers exceptional benefits for the NHS. The partnership model is good value for money and allows GPs and their teams to deliver tailored and optimal care to their local populations. It needs support, but there would need to be a very good reason for changing a model that works well for patients, the NHS and the taxpayer.”

British Medical Association GP committee chair Dr Farah Jameel said: “The problem is that there are simply not enough GPs, and those that remain are being stretched thinner by the day. Every month, more and more GPs leave the service and the public are understandably horrified when they lose their local practice. A radical approach is necessary to address staff shortages, unbalanced investment and misaligned incentives. However, that does not mean taking a sledgehammer to the partnership model.

“The recent GP contract changes announced by NHS England and NHS Improvement demonstrate an example of the challenges we still face. Despite our best efforts to outline a number of positive and constructive solutions that would make a difference to practices’ ability to improve care for patients, NHS England has instead decided to follow a path laid out three years ago, long before the arrival of COVID-19, and roll over a contract that fails to address the current pressures faced by general practice. This is why, for all the talk about the future of general practice, it’s vital we don’t lose sight of what’s happening today.”

Dr Jameel added: “The latest data show that over the last year England has lost the equivalent of 279 fully qualified full-time GPs, with 91 having left in the last month alone. This loss of 91 GPs works out as the equivalent of more than 200,000 patients having lost their family doctor between December and January – while at the same time we have gained 130,598 new patients1. The immense loss of these colleagues will be sorely felt across the entire health and social care system.”

Two other medical organisations combined to criticise the NHS England approach to GPs and its decision to impose contractual changes, warning of the risk of legal action.

In a joint statement, the Doctors’ Association and GP Survival said: “We are furious that NHS England have chosen to ignore the collective plight of frontline GP teams. The unilateral termination of negotiations by NHSE demonstrates a complete lack of respect for GP teams who have worked tirelessly throughout the pandemic whilst also contributing to the largest vaccination programme in the history of our nation. The deal being imposed upon GP contractors needs to be legally tested as it represents a fundamental change to GP contract terms and conditions with no clear defining reason for it.”