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The pressure to earn quality points is causing friction in some practices, which are redrafting their agreements and including sanctions clauses – solicitor Daphne Robertson explains

One of the results of the new contract is that partners are re-examining the business relationships in the light of the Q&O targets. Each partner's personal effort is now under scrutiny to see that the service levels set out in the PCO and PMS contracts are being achieved.

For many GPs an awayday and regular practice meetings to re-examine the direction of the partnership has produced some very positive results. Partnerships consisting of GP partners with similar goals find they are able to deliver patient services more effectively and make use of their practice resources more cost-efficiently.

As a consequence of this restructuring, each GP's individual practice style can be absorbed, practice staff are more highly motivated and the whole practice is perceived by patients and the local PCO as pulling together. The likelihood of a partnership dispute is considerably reduced, and it is not surprising that such practices tend to be higher earners.

However, for other practices the emphasis on contracting to provide a specific level of service and achieving a target number of points has caused friction. GMS2 and PMS capitalise on the skill mix in the practice but with this comes greater scope for divergent views on how the practice should be run.

A significant number of GMS2 and PMS practices are currently experiencing levels of disharmony that need to be harnessed before the situation develops into an explosive partnership dispute or a premature retirement. Either of these eventualities are time-consuming, stressful and costly for the practice. In fact they are now more devastating than ever since they can result in the loss of a high achiever or a partner who is solely delegated to perform a practice service. What steps can partners take to minimise this happening?

The two crucial things are, first, to ensure the partnership agreement contains adequate mechanisms to reward partners who are performing up to the level of the standards required in the GMS2/PMS contract and the Q&O framework, and, second, to introduce ways of dealing with under-performing partners who are prejudicing the practice.

This means not only ensuring that there is an exit route for an under-achieving partner but also that there is a mechanism for helping that partner to improve and re-establish their position in the partnership. So what clauses in your partnership agreement should you scrutinise closely?

1The old definitions of full-time partners, three-quarter-time partners and half-time partners are obsolete. Set out the commitment of the partners, perhaps by reference to the number of sessions undertaken each week and a 'points' system. Since this is likely to change, possibly include it in the practice minutes rather than in the partnership agreement itself.

2Ask yourself, should partners cease to be tied to equal profit shares? Should a 'star' partner who exceeds all their targets be rewarded with a compensatory bonus? This is only possible in partnerships that do regard the targets as practice targets but delegate services to individuals so under-performance can be objectively measured.

3Should an under-performing partner be penalised by having to repay any financial 'loss' to the partnership (with or without interest)? This could be a discretionary requirement exercisable only in the most extreme of circumstances. Its existence will serve as an incentive not to be complacent.

4Do you feel inclined to include strict warning procedures to an underperforming partner, such as those that you have for your staff? Since partners are not employees I prefer not to include such measures, but some practices feel they are necessary.

5Is there an obligation to require a partner, at the cost of the requesting partners, to seek the opinion of an independent consultant on his fitness to practise as a partner in the practice? This can be an effective tool if a partner has no insight into their problems.

6Are there adequate obligations to ensure partners keep up to date with their continuing medical education and their appraisal records?

7Can you suspend a partner while you explore your expulsion rights?

8Are your expulsion clauses up to date? Do they adequately cross-refer to breaches of the GMS2/PMS contract and the Q&O framework?

9Should you consider the inclusion of a 'Mexican shoot-out' clause in case under-performance does not fit precisely into the defined expulsion grounds in the agreement? Such clauses provide for an immediate expulsion without the establishment of any precise expulsion grounds

The Q&O framework is definitely making it more important that practices work together in harmony, and if you think you may have problems, you should seek the advice of a specialist solicitor.

Daphne Robertson is the founding partner of DR Solicitors, London

Elements to consider for

your partnership agreement

•Introduce a number of sessions requirement, or a points system for partners

•Consider introducing a compensatory bonus or financial penalty for partners

•Introduce a warning procedure for partners

•Consider introducing a reporting system on fitness to practise

•Have a clause relating to continuing medical education obligations

•Have a suspension clause

•Have an expulsion clause

•Consider introducing a 'Mexican shoot-out' clause

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