Dilemma: Downsizing partner
One partner wants to ‘downsize’ – to stop being a partner but stay on as a salaried doctor, covering about 50% of his/her previous clinical sessions. How do you cope with the situation?
Explore the issue and seek expert advice
This is becoming a common issue these days, with the workforce either retiring or choosing other commitments over the practice. At the start of this discussion, try to be supportive.
My suggestion would be, firstly, to explore the issue. Depending on your relationship, ask whether there any changes in the practice working conditions or within the team that could help and might change your partner’s mind.
Secondly, I would ask what their thoughts are, how they think the practice will survive and what suggestions they may have.
They may have some remedies already.
Thirdly, I would want to assess how this will affect the workload and the liabilities of the practice, partnership agreements and safeguards and payflow. Consider possible solutions to cope with the change, such as employing more salaried GPs or another partner. It may be an opportunity to consider new projects or other improvements. Seek advice, if need be, from the BMA, LMC, MDU and your accountant as well as from colleagues.
After the initial discussions with your colleague, you need to meet them again after you have consulted all the partners and offer an open dialogue with solutions.
It is important to share your views as well as discussing future plans - both short- and long-term. Finally, come to an agreement based on the timings you have agreed on. This last stage may be a lengthy process, but it will be worth it in the end.
Dr Jagan John is a GP in Barking and clinical director of NHS Barking and Dagenham CCG
The impact on patients must not be neglected
First ask why the doctor wants to step down: the underlying reason for wanting to downsize would probably drive the direction of the whole change process and set the course for your future relationship as employers of your ex-partner.
The downsizing partner´s expectations of their new role, responsibilities, contract, pay, and terms and conditions must also be explicit at the start of what could be fraught negotiations.
It may also be that this change does not suit the partnership as a whole and there is no reason that the partnership is bound to accept this proposal. The repercussions of rejection could however, precipitate the partner’s departure or even a partnership split.
There appears to be an opportunity for your partner to reduce their clinical and management responsibilities in the practice, while allowing the rest of the partnership to have a good look at their practice. The temptation is always to replace like with like, when in fact sometimes it may be better to do something completely different.
Not only will there be clinical sessions to fill, the partnership role will need to be taken over as well. It may be a chance to shuffle things around in a way that advantages everyone, and a shuffling of responsibilities and roles may help to keep the partnership fresh. New blood could also bring new vigour and enthusiasm.
Whilst focusing on the practice, the impact upon patients must not be neglected. Their beloved long-standing GP is now only available half as frequently as previously, and how the surgeries are replaced may have unforeseen consequences.
The new role will bring a new association with the partnership for the downsizing partner. Help the doctor manage the transition from partner to employee and anticipate any changes to the partnership dynamic that their departure might create.
Dr Richard Van Mellaerts is a GP in Kingston, Surrey
Consider employing another part-time salaried GP
Assuming that the other partners are happy for the change to take place, bear in mind that the cost to the practice of the ‘new’ employed GP will include their gross salary, employer National Insurance contributions and employer pension contributions.
Use the proposed change as an opportunity to review the practice structure and staffing levels. In particular, look at the supply of, and demand for, clinical sessions.
Is there a role for telephone triage? Could some patients be seen by a nurse or HCA rather than a GP? There is anecdotal evidence that some patients see their GP on a regular basis, perhaps out of routine. Could these patients be identified and dealt with in a different way?
If you do decide that extra GP capacity is required to meet the proposed reduction, could this be met by other partners in the practice? Everybody needs to consider their work/life balance but cover by other partners can often be more flexible, and it is worth nothing that a feature of higher earning practices is often ‘self-cover’ during periods of partner absence.
If there are no more partner sessions available, then consider another part-time employed GP, although bear in mind the ‘add-on’ costs noted above.
Another alternative might be locum cover, although this tends to be more expensive than the other options, especially bearing in mind the 14% employer pension contributions now payable by practices. We would therefore normally recommend that locum cover be used only for shorter-term absences.
Ask your accountant to calculate figures to help you to understand the effect of these alternatives on partnership profits and therefore the amounts available for partners’ drawings.
Barry Rigby is a director at John Goulding & Co, a member of the Association of Independent Specialist Medical Accountants