Should general practice give up the independent contractor status?

The independent contractor status of GPs has been an article of faith since the NHS was established in 1948.A salaried service was devised for hospital consultants but essentially, GPs have been self-employed ever since.This has led to the small business model of general practice and was at the heart of the partnership system.Now many GPs opt for sessional, salaried, often portfolio employment, and the number of GP partners is in steady decline.Some regard the disappearing partnership system as the loss of a golden age of general practice, a flowering of the independent contractor arrangements.Partnerships were invested in the local community, quick on their feet, and able to respond swiftly to change and challenge.A recent survey by the General Practitioners Committee of the British Medical Association (BMA) revealed strong support for the independent contractor status, even among salaried GPs.Others see the small business approach as inefficient, outdated, and unattractive, with a trend towards federations, super practices, and increased salaried working, to achieve economies of scale in management, infrastructure, and clinical resources, and to provide wider ranges of patient services.We asked five well-qualified commentators for their views on whether the time has come for general practice to give up the independent contractor status.