Mr. Val Moran:

We had a little discussion on this earlier. The issue with having two different systems working side by side is that it makes it very difficult to do that. With regard to GPs working in rural areas and areas of deprivation, some strides have been made in recent years, in particular on the deprivation side under the IMO GP agreement where an additional amount of funding is going to the top 150 practices working in areas of deprivation. That has helped. There will be a further roll-out of that this year and a new system going in towards the end of the year that will help with deprivation.

On GPs in rural areas, we need to expand the supports that are available. They were agreed around ten years ago. There is a need to look at that and to support GPs in that area. I do not think the way to go is a system whereby we would publicly fund everything and the GP would work within it. The independent contractor model has given us the best of both the private and public systems. There is some entrepreneurial spirit among GPs, and we also have their clinical dedication to their patients. It is very hard to see how two separate systems would marry up with regard to the out-of-hours system. If they are employed, is it suddenly the case that paperwork currently being done in the evenings would no longer be done? How would it work? If certain services are provided on a fee-per-item basis in the existing system but not on a fee-per-item basis in the employed doctor system, will the employed doctor have an incentive to do these things? We have incentivised certain parts of care in the way it is set up. For the CDM programme, for example, the GP does two scheduled reviews per year and is paid a certain amount for that. An employed doctor is paid the same, regardless of what he or she does, so it is difficult to look at that.

There is a role for an employed doctor. It is already in general practice and it is working in existing GP surgeries. Once a number of doctors are finished their training, they may want to work as an employed GP for a number of years but after that, they may want to take on a practice in their own right. Even if there were an employed GP in a certain area, it is not the case that he or she would stay forever, which would mean that continuity of care would be suddenly lost. With the existing system, where GPs invest in the area and in practices, they are committing to the area and that helps with continuity of care.

In short, that is not a system we would look at because there would be too many difficulties with it. We have had reform overload in the health service and sometimes we need to improve the system we have to the greatest extent possible rather than going back to the drawing board because we would end up going backwards before we can go forwards and never get to the destination.