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At the heart of general practice since 1960

Buckman’s eyes on the partnership prize

The GPC chair will have a tough job convincing the Government not to scrap seniority payments. So will his plans for reforming the system work – and in doing so give him a lasting legacy?

The GPC chair will have a tough job convincing the Government not to scrap seniority payments. So will his plans for reforming the system work – and in doing so give him a lasting legacy?

Dr Laurence Buckman is not everyone's cup of tea as GPC chair. He doesn't have the natural poise Dr Hamish Meldrum brought to the role, and his combative, even tempestuous, nature has lost him a few friends. But Dr Buckman is a man who cares about patients and cares about doctors. In the pressing need to find a solution to the lack of partnerships available in general practice, he has found an issue that may offer him a lasting legacy.

Dr Buckman has already secured the GPC's support for his attempts to negotiate a return of the Medical Practices Committee, to bring some Government control to the distribution of partners across the country. That move may well be doomed to failure, with the noises coming out of the Department of Health distinctly noncommittal so far. But Dr Buckman now appears to have a new plan up his sleeve. The GPC, as Pulse reveals this week, is discussing a proposal to turn seniority payments into an incentive scheme either to increase the supply of partnerships or properly reward salaried doctors for length of service.

The various options are complex and each has its own problems. Under one, seniority payments would be uncoupled from seniority and linked to the number of sessions worked instead. Under another, the seniority money would be subsumed within the global sum, which would be newly linked to the number of partners. Both these models could provide a strong incentive to fill partnership vacancies, but would fail to do the current job of rewarding experience.

A third, radical option would see seniority payments written into the BMA model contract for salaried doctors. It would allow salaried GPs to move up the salary scale as they became more experienced, which of course would make them significantly more expensive. Partners might not welcome that, but it would strengthen the incentive to appoint a partner instead.

The GPC does need to do something imaginative just to keep the almost-£80m of seniority payments. The Government has already frozen them for this year, and seems intent on phasing them out altogether unless it is given a good reason not to do so.

The negotiators will hope the preservation of the partnership model of general practice could just be that reason.

It will take some hard sell. The DH has assiduously avoided getting itself dragged into the debate over the relative merits of partners versus salaried GPs. It has declared the GPC must ‘show us the evidence' that partners, with their greater financial and emotional stake in their practices, offer something concrete that salaried GPs cannot. Dr Buckman must present a persuasive case that partnerships are essential for a profession engaged in Government priorities such as commissioning and clinical leadership.

If he does so, the prize may be an £80m incentive scheme for new partners, and a key role in preserving the independent-contractor model of general practice.


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