A seemingly minor change to the GP contract that pre-dated the larger 2003 complete re-negotiation was that GPs are no longer medicolegally responsible for the actions of a deputy whom they appoint: the deputy is responsible for themselves. A consequence of this is that GPs are less concerned about whether they are in legal partnership with all the doctors who look after their patients. The legal change, coupled with the new trend for new doctors to delay applying for partnerships, has led to a rapid rise in the number of practices who are willing to recruit salaried GPs.
These doctors are employees of the proper partners in the same way that the practice nurse is. Because they are not partners they have no financial stake in the building or right to make or influence partnership business decisions, and they have no non-clinical duties such as being responsible for equiping the practice, repairing the building, hiring and firing receptionists, negotiating with the NHS etc etc.
In recognition of the fact that these salaried GPs only do the clinical work and not the administrative work, they are currently paid less than a full partner. However, because demand for them exceeds supply the reality is that they aren't paid that much less: currently (Feb 2003) posts are advertised at around £55000 per year.
The GP labour market at the time of writing is therefore rather uncertain and, because contract negotiations are in progress, it is difficult to separate lobying from the truth in what is reported. The BMA points out that the number of posts still vacant after 3 months is rising, and anecdotally there is evidence that it is increasingly difficult to recruit partners. The NHS for its part has recognised that there is some kind of recruitment crisis through the introduction of various golden hello, golden handcuff and pat-on-the back financial reward schemes.
Meanwhile, the status of Primary Care Partnerships as independent fiefdoms is also under change through the introduction of Primary Care Trusts. These are groupings of several practices- typically 10 or 15 (thus approx 30-40 GPs) under the auspices of a single administrative body that seeks to provide some overarching locally informed policy. PCT boards are predominantly made up of GPs, but have a sizeable representation from other helathcare professional and lay groups in the local community (who often feel that progress is being stifled by the GP stranglehold on the board).
Originally the raison d'etre of PCTs was to take a larger-scale view of local health needs and health purchasing requirements than was the case with practice based fundholding. However, they are starting to widen their role. Some are employing salaried GPs directly. For example they may employ a female GP who then works one day a week in 5 different single-handed practices where there is only a male partner and therefore no choice for female patients. PCTs are also beginning to attempt to get a grip on the information that would help them manage, namely the practice computer systems. Some PCTs are trying to change all their practices over to a common system. A few are going further and centralising the physical computing and data warehousing facilities.