One of the questions I am most regularly asked is why I am so supportive of the independent contractor model of general practice.  Wouldn’t life be easier and simpler for GP partners if they were free to operate as clinicians, without the almost full time distraction of trying to run a small business?

For many the grass does look particularly green on the other side of the fence, where GPs as part of NHS organisations could work reasonable hours, take annual and sick leave like any other employee, and be free from all the stresses of income, cash, staff, property, and unreasonable partners.  Life looks like it would be so much simpler.

Why, then, do we prize the independent contractor model so highly?  Well, as with any situation where we are looking to move away from problems instead of towards something we want, life on the other side will always contain its own set of (albeit different) problems.

Peter Muchie summed it up really well when he described his own experience of making this transition,

“And then I surrendered my independent contractor status to become a salaried employee with an NHS out-of-hours service. To me this now equates to a surrender of power and the right to self-determination. I can no longer organise my work to best meet competing demands. I can no longer negotiate with equal partners, but must accept the impositions of a cost-cutting management which seems to work toward the lowest common denominator. I can no longer decide what to accept and reject…

I no longer have total freedom to develop my skills according to personal interest or to best meet the demands I perceive. I must instead undertake ordained ‘mandatory’ training on such delights as information governance, and diversity in the workplace. This is boring, irrelevant, and time-consuming, the main purpose appearing to be to protect the monolith for which I work, not to improve the care I give.

When I identify a real opportunity for workplace improvement I have no real power to address it. I pass it up a non-responsive bureaucratic chain to a distant and removed manager, focused on budgets and generalities. My concern is either ignored or cursorily acknowledged and placed at the bottom of a list of priorities with cost cutting, and not service improvement, at the top.” Peter Muchie, BJGP Should General Practice Give Up the Independent Contractor Status 2015.

It is easy to think that we would just turn up for work, see the patients we were asked to and then leave at the appointed hour.  But what we miss is how soul destroying this lack of autonomy will feel, how frustrating the constant interference of a middle manager with a corporate agenda and no insight into the needs of our population will be, and how being at the receiving end of decisions made at an organisational level many layers away will make us want to scream.

The independent contractor model offers freedom for practices to choose how they operate, to flexibly adapt to meet the needs of the patients they serve, and to respond quickly to any new situation that arises and requires action.  This has been a key strength of general practice, one that is not well understood, but one that would be lost if the model was replaced.  It not only enables practices to adapt and thrive in even the most testing circumstances, but also provides partners that Maslowian need for self-determination that a salaried model would take away forever.