The Labour party has launched an offensive against general practice in recent days.  First the Shadow Health Minister Wes Streeting says he wants to “tear up” the “murky, opaque” GP contract, and now Labour leader Keir Starmer has doubled down on the comments and said he wants to take away the GP contract and make GPs direct employees of the NHS.

Now we are in the odd position of the Conservative party defending the GP partnership model.  In Prime Minister’s Questions on 11^th January Rishi Sunak said, “‘I’ll tell you what the NHS doesn’t need. What they don’t need is Labour’s idea – Labour’s only idea – which is for another completely disruptive, top-down, unfunded reorganisation buying out every single GP contract”.

Maybe Labour’s position is not surprising.  They wanted to nationalise general practice back in 1948, and only reluctantly agreed to the current situation in order that they could push ahead with introducing the NHS.  Since then GPs have maintained such huge popularity ratings with the general public that it has been impossible for them to challenge the independent contractor model, and to press ahead with any plans to nationalise general practice and bring it in line with the rest of the health service.

But now things have changed.  The popularity of GPs has fallen sharply as access challenges have risen and the media campaign demanding immediate access to an in-person appointment with a GP has continued largely unchecked.

Labour has pounced on this opportunity and is now portraying GPs as money-grabbing private contractors, who undertook the vaccination programme for no other reason than personal financial gain, in an attack that they would have not even considered only a few years ago.

Of course, this flies in the face of any reasonable analysis of what is going on.  The recent Health and Social Care Committee Inquiry Report into general practice (an all party document!) reported that, “Historically one of the key drivers of innovation and improvement in general practice has been the GP partnership model, which gives GPs the flexibility to innovate with a focus on the needs of their local population. We know there are significant pressures on GP partners at the moment but the evidence we received was clear that the partnership remains an efficient and effective model for general practice if properly funded and supported… Rather than hinting it may scrap the partnership model, the Government should strengthen it” (p4).

There is a belief amongst some that others (“professional NHS managers”) would be able to manage general practice better than GP partners.  But only last week a hospital in Swindon returned the contracts of two GP practices so that they could have “more opportunities to draw upon shared learning and best practice” from nearby practices.  It turns out running practices needs its own expertise, and this is not one that currently exists in other NHS organisations.

The idea that introducing the very NHS bureaucracy to the service that the government has consistently said it is trying to cut from the health service would be somehow a solution to the challenges facing general practice can only be described as political, and never as either pragmatic or realistic.

But ultimately the NHS is political.  General practice at a national level is not functioning as an effective political operator.  So while the logic of Labour’s political position is not intellectually defensible, unless general practice gets its act together nationally it may well be that the GP partnership model will end up as a political casualty, should Labour maintain its current lead in the opinion polls and win the next election which will take place within the next two years.