Margaret McCartney: We need more openness on GPs’ pay
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2729 (Published 16 May 2016) Cite this as: BMJ 2016;353:i2729
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It is clear that there is a need for new and innovative models of primary care delivery. Our current models don't serve patients well and it is hard to argue with a colleagues comment that, "The department of Medicine is the biggest marketing wing of the drug companies".
We should take the lead from innovative Physicians like Dr Dean Ornish and Professor George Jelinek. They have shown that by addressing known risk factors for disease you can get impressive results. Dr Ornish demonstrated that lifestyle change alone can prevent the progression of localised prostate cancer and reverse heart disease. More recently Prof Jelinek has shown that people diagnosed with Multiple Sclerosis (PwMS) can actually improve if they address the known risk factors for this disease.
Primary care should promote the application of Public health knowledge. We have been shown what is possible and Primary care Physicians are in prime place to deliver these changes.
Dr S Gartland
MRCP (UK) FRACGP
http://www.ncbi.nlm.nih.gov/pubmed/16094059
http://www.ncbi.nlm.nih.gov/pubmed/9863851
http://www.ncbi.nlm.nih.gov/pubmed/22367222
http://www.ncbi.nlm.nih.gov/pubmed/25638416
http://www.ncbi.nlm.nih.gov/pubmed/24628020
Competing interests: I recovered from MS following the Overcoming MS programme and now work for the organisation.
Margaret is spot on about problems with pay transparency but the future might look very different.
It seems that the GP independent contractor status is the cause of much of the problems and as this may well be coming to an end in the near future, we have an opportunity to rethink careers in primary care medicine.
Primary care is becoming an increasingly challenging environment with more chronic disease management across different specialties and greater clinical complexity. It therefore needs a training programme at least as long as that of hospital specialties, where training lasts between 5 to 8 years. As well as more time in different specialty areas, additional rotations could also be completed in commissioning and public health settings and even in the third sector. With the increasing demands of clinical risk communication, statisticians and behavioural scientists could also be invited to develop a new curriculum fit for modern clinical practice.
As the recruitment figures tell us, the specialty also needs a facelift. Why is general practice the only specialty not to have a consultant grade? We have junior (FY2) and senior trainees (ST1-4), so why not an equivalent grade for senior doctors? Why not have consultants in 'family medicine' who would be on the same payscale as hospital consultant colleagues? The term is widely used around the world and could help rebrand a specialty that is carrying many ghosts.
It is time for a 'family medicine' revolution?
Competing interests: No competing interests
Re: Margaret McCartney: We need more openness on GPs’ pay
Margaret's article is thought provoking but has more sentiment than science. The comment about 'managing many other doctors' is not well researched, and the author need to look no further than page 421 of the same weekly publication - BMJ 2016;353:i3195. The GMC now regards the role of doctors to include managing other doctors, whether they are working in egalitarian, cooperative groups or as a GP chief executive of a super-practice. Face to face consulting is essential, and will continue, however, it can be made more effective and efficient by quality control.
Competing interests: No competing interests