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GP leaders plan overhaul of 'unsustainable' general practice

By Steve Nowottny

The BMA and RCGP have begun radical moves to overhaul the business model of general practice, which they warn has been rendered ‘unsustainable' by desperate shortages in GP partnerships.

Under far-reaching proposals, the traditional practice-based model would be phased out over as little as five years, with GPs of the future working under large umbrella organisations.

A new policy paper envisages the end of distinct partner and salaried GP roles, to be replaced by a team-based system headed by a new breed of ‘primary care directors'.

‘A collective helplessness and confusion is pervading the profession,' warns the Changing Partnerships paper, written by leading members of the college and the GPC.

‘Those in the lucky position of being partners are set against the ever-growing workforce of salaried doctors,' it warns, adding: ‘The traditional small-business model of general practice is unsustainable.'

Salaried GPs and partners could take on roles ‘not based on ownership but on the function each provides', the paper says. ‘This new federated model of working will necessitate new roles for GPs working as teams and replaces the current salaried and partner divisions.'

Some would work as ‘traditional GPs' focusing on clinical care, some as GPs with particular interests such as commissioning and a third group as ‘primary care directors', with responsibility for management.

It is the first time the BMA has thrown its weight behind the RCGP's federated model, with the paper providing the first details of how the system would work in practice.

Dr Clare Gerada, co-author of the paper and RCGP vice chair, said: ‘Partnership is a very good model and has served us well. But where we are now, with large areas of the country not creating partners, we need to look at a third way.

‘There's going to be grassroots GPs out there who say, "Over my dead body am I going to have some medical director who's not a partner" – but us oldies can't do all the work. If we look five or 10 years down the line I think the majority of practices will be working under some sort of federated model.'

Within federations, practices would remain independent contractors but become ‘more uniform' under a ‘corporate overarching management structure'. They would also gain economies of scale, aiding competition with private providers.

Dr Richard Vautrey, deputy chair of the GPC, said the BMA had backed the federated model as one way of tackling the salaried-partner divide, though he stressed it was not a ‘one-size-fits-all approach'.

‘It's a way of encouraging smaller practices who would gain benefit from sharing resources while retaining their independence,' he said.

Dr Peter Stott, medical director of the Epsom Downs Integrated Care Services (EDICS) federation of more than 20 practices in Surrey, said the model could help tackle the profession's jobs crisis.

Under the EDICS model, salaried GPs are given opportunities for career development and shared ownership, and practice nurses and even receptionists can become shareholders.

‘Just like in any other area of corporate work, you have a career ladder,' he said. ‘One of the tragedies of my generation is that we've let down young GPs.'

The end of the salaried-partner divide?

• The Changing Partnerships document suggests three new roles for GPs, open to both partners and salaried GPs

• ‘Traditional GPs' – GPs focusing on patient care,
the role described as ‘the backbone of quality general practice'

• GPs with other interests – GPs who in addition to clinical work take on other roles, such as commissioning, academia or clinical leadership

• Primary care directors – GPs who, while maintaining a clinical workload, take the lead in running and managing both practices and federations on a day-to-day basis

BMA and RCGP propose an overhaul of the broken model of general practice in the UK BMA and RCGP propose an overhaul of the broken model of general practice in the UK

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