Doctor 2General practitioners should give up their independent contractor status and become NHS employees. This is the most radical alternative method of primary care funding considered by Professor Azeem Majeed, Head of the Department of Primary Care & Public Health at Imperial College London, in an editorial published today in the Journal of the Royal Society of Medicine.

Professor Majeed, who also works as a part-time GP in South London, suggests that the funding of primary care should also be modified in favour of methods that link workload more closely to funding.

In the last few years GPs have seen a dramatic transformation in their circumstances with reduced funding and higher clinical and administrative workload. Professor Majeed says: "Under the current capitation-based funding method, GPs face unrestricted demands for their services and on their time while having to operate on a fixed budget." When GPs are unable to cope with their workload, he says, pressure will increase on other parts of the NHS - such as emergency departments - as well as impacting on access to primary care services and on how well GPs can manage patients with complex health needs.

If GPs gave up their independent contractor status, they could become NHS employees under similar employment terms to doctors working in acute, community and mental health trusts. This could, says Professor Majeed, allow GPs and their staff to be employed on national NHS terms of service and overcome the divide between self-employed GP principals and salaried GPs.

Other options considered by Professor Majeed include the incorporation of tariff-based methods of funding in place of or in addition to capitation payments; the establishment of 'super-partnerships' involving the merger of general practices to allow the formation of larger primary care organisations; or greater collaboration between general practices via the formation of general practice networks or federations.