GPs look for safety in numbers
By Rob Finch
The herd instinct is a classic reaction to danger. Animals group together to avoid being isolated and picked off by hungry
It's an impulse with which GPs can identify at the moment.
With private health care providers prowling primary care like big cats on the plain, GPs have every reason to feel like the hunted.
So to give themselves a bigger chance of fighting off this threat, they are increasingly banding together hoping they will have strength in numbers.
In Avon, 86 practices that fear they will be stripped of their central role in primary care provision have formed a limited liability partnership called GP Care. In existence since January, the partnership covers 700,000 patients across five PCTs.
Practices have invested 50p per patient in order to sign up, giving the partnership a fund of around £400,000. Its aim is to bid for contracts to provide a wide range of services, from out-of-hours, urgent care and referral management to enhanced services and even potentially to take on struggling practices.
Dr Simon Bradley, interim managing partner of GP Care and a GP in Little Stoke, Bristol, says setting up the partnership is about 'taking a positive attitude' to the influx of competition. 'The first rule of defence is attack,' he says. 'We recognise we have to be in a position to compete on a range of services, using economies of scale.
'Opportunities are huge. I don't think the Government's intention is for general practice to step up to the block but that's what we're trying to do.'
Dr Bradley says they decided on a limited liability partnership because it has more of the advantages of a typical GP partnership and fewer risks than limited company status (see box).
Profits for individual members are limited, but so are potential losses. Tax is also levied in the same way as traditional GP partnerships.
GPs who have signed up say they were happy to dip into their own pockets, even though they had to trust that the organisation would help them.
Dr Stefan Cembrowicz, a GP in a 16,000-patient practice in Bristol, says GP Care reflects
the 'protectionist' mindset GPs have developed in recent months. Buying into the partnership cost his practice around £8,000. The level of investment by practices 'shows they mean business', Dr Cembrowicz says.
'We'll have a workforce large enough to tender for the services we already provide against the likes of Tesco or Boots.'
Dr Tom Frewin, a singlehander in Clifton, Bristol, with 3,500 patients, says without the back-up of the limited liability partnership, there is little additional work small practices can do.
He says: 'This is a way around that. I can look after drug addicts, but I would like to send minor ops to another practice and have them paid for doing it.'
GP Care may be the largest GP-led limited liability partnership, but it is not the first such venture.
Epsom Downs Integrated Care Service (EDICS) launched as a limited company last year covering 121,000 patients but has had a difficult beginning. Contractual problems with its local PCT have hampered it from taking on contracts.
Dr Peter Stott, medical director of EDICS and a GP in Tadworth, Surrey, warns that organising such a company was not easy because it needs GP buy-in, friendly hospitals and respected clinicians in charge of service redesign.
He says: 'There's tremendous potential we're aiming for a process driven by clinicians that is clinically meaningful.'
GP Care, EDICS and other conglomerates of GPs are very much in tune with the Government's exortations to practices to link up.
Professor Alan Maynard, professor of health policy at the Centre for Health Economics at the University of York, says limited liability partnerships are a 'rational response' to the instability being created in the NHS.
He adds: The Government is pursuing its Maoist policy of continual cultural revolution in the health service. It's difficult to anticipate where it will go.' It is this uncertainty that leads some GPs to urge those considering setting up multi-practice organisations to tread carefully.
Dr Richard More, a GP in Yeovil, Somerset, and director of Xytal, a company that advises on contractual issues, says GPs need to think hard about which sort of grouping they sign up to.
'There are pros and cons on management, pensions, social ethos and so on,' he says. 'Before doctors can seriously decide on the answer, they need a lot more tutoring on the question.'
It's a point Dr Michael Taylor, chair of the Small Practices Association, echoes. He says: 'The devil is in the detail, even though, superficially, it's a good idea.'
Dr Taylor also points out that not all GPs possess the 'herd instinct'. Indeed, he says GPs have at least one thing in common with the predator role, which may hinder any joint ventures.
'Getting GPs together is like herding cats,' he says.
Limited liability partnerships how they work
· Partners are liable for debts incurred by the company but only up to the value of their buy-in. They are also limited in what profits they can take.
· LLPs are taxed as a partnership and have the same flexibility but are like companies in every other respect.
· They need to be incorporated through Companies House, have a registered office and return accounts every year.
· They need at least two 'designated members' who must appoint auditors, and sign and deliver accounts.