The inevitable demise of the independent contractor status

Azeem Majeed and Naureen Bhatti make a compelling case for giving up independent contractor status, while Rebecca Rosen suggests that this would result in ‘some wins’, but would not be worth the disruption that enforcing it would cause. In fact no enforcement is necessary. The inevitable demise of independent contractor status is already being facilitated by our profession.

Roger Jones rightly points out that many GPs are opting for salaried roles. Uncertainty over the future of general practice combined with inflated fears of the responsibilities of partnership undoubtedly play a role in this choice, but for many young GPs a salaried assistantship is the only employment option on offer. In an increasingly difficult economic climate, partnerships are replacing partners with assistants not to meet the needs of the next generation of GPs, but as the only means they have of maintaining or increasing the incomes of the remaining partners. However, subsidising partners’ incomes from the lower pay of assistants is an uncoupling from economic reality that can have only one consequence.

The government’s intention to make general practice a 7-day service is both good for patients and a tool for promoting practice federation, the key to modernising primary care. Combining this with a clamp on primary care funding appears illogical but ensures that more and more partners will be replaced by assistants until partnerships become neither viable nor identifiable. When partners themselves demand a salaried service, no doubt to be managed by private healthcare providers, they will be surprised that the money on offer will be based on the average salary of an assistant, not that of a partner. In the interests of self-preservation, they will have extracted all the gold from the ‘golden era’.

The small business model may seem to serve a dwindling elite of general practice partners but no longer serves the interests of patients or today’s young doctors. It should be abandoned while our leaders are still in a position to negotiate terms.

• © British Journal of General Practice 2015