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Save GPs left as 'last man standing', GPC tells NHS

Exclusive GP leaders across the country are calling on commissioners to step in to save ‘last-man-standing’ practices by taking on premises leases, redundancy payments and employment rights.

Dr Charlotte Jones, member of the national GPC executive and chair of the Welsh GPC, said fear of being left with liabilities is driving ‘a succession of resignations’.

She is calling, as part of the annual contract negotiations with the Welsh Government, for a national process that would see health boards more consistently bailing out GP partners left in the lurch.

It comes as Pulse has reported on practices where the GP partners are at risk of personal bankruptcy because of having to hand back their financially unviable contract.

In Scotland, the GPC has taken part in a working group with Scottish Government and health board officials looking at how to address the last-man-standing issue, the results of which ‘will inform ongoing contract negotiations’, a BMA Scotland spokesperson said.

And in Northern Ireland, a BMA spokesperson said this was ‘one of a number of issues’ under discussion with the Health and Social Care Board.

GPC deputy chair Dr Richard Vautrey said the situation in England was less straight forward because unlike health boards, CCGs do not take on the running of failing GP practices.

But he said that GPs fearing being left in that position should urgently contact their LMC to look at local solutions such as being taken over by federations or community providers.

He added: 'There are also a number of companies who are supporting practices in these situations so there are different organisations who could do that.'

Writing to Welsh LMCs to update them on the progress of negotiations, Dr Jones said the Welsh Government has said health boards can already step in to help partners, but the GPC will be pushing for stricter guidance in contract talks.

She said in the letter: ‘They have utilised one or two of these options on occasion, but we need to build on that.

‘They should look to support these practices and reduce the liabilities on the individual. We want to make sure health boards are using all these options to support practices in a consistent way.’

Pulse already revealed that GP partners in many areas are reluctantly ditching partnerships and moving to salaried roles, in part to avoid being left with liabilities.

Practices closing across the UK

In England, practices are closing while waiting for support packages. But Pulse revealed last week that NHS England has spent less than half of the £10m fund to save at-risk practices almost a year and a half after this was first announced.

For Wales, the GPC has warned that one in 10 practices is at risk and GP Survival found 20 practices handed back their contract to the health board in the last year.

A BBC Scotland investigation last year found NHS boards in Scotland had taken over 42 practices due to the continuing GP recruitment crisis and more handovers were on the cards.

In Northern Ireland the situations is so bad GPs are plotting an exit from the NHS, and there are fears that there will soon be a whole town without general practice because of practice closures. 

Readers' comments (27)

  • Buck House gets £369m for renovation , public funding for the richest woman in the world. General practice gets £10m . The signal is loud and clear.

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  • Mr Mephisto

    Portadown the "whole town without general practice" mentioned above looks like its heading for the exit.

    This will leave the Northern Ireland Assembly with the rather difficult and embarrassing problem of 40,000 patients without a GP - lets see how they manage that disaster.

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  • While I have some sympathy for the last man standing, I find it difficult to be completely sympathetic when GPs have been happy to take the money previously. Any business has risk and liabilities.

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  • Don't sign any leases unless linked to your GMS/PMS contract. Especially with the very large number of private companies out there willing to build your practice but want Personal liabilites from the GP partners for a full 20-30 year lease. When you lose the contract for any reason (GMC, CQC, parterns leaving and unable to recruit) they will come after your house, car all savings that you might ever have. Beware. you have been warned.

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  • It just boggles my mind that anyone believes that “working at scale” or a salaried corporate model will be MORE efficient than the 4-5 partner skin-in-the-game / c.10k patient practice model that has kept some kind of lid on costs for the last several decades.
    This is all going to end very badly. It will end up costing more, contracts will be “handed back” and people will have to pay for a decent GP service if that’s what they want.
    The people driving this probably operate at the level of “it worked with the dentists, why not GPs?” Err, no disrespect but the very reason the politicians got away with that one is that toothache doesn’t kill you. Well not easily anyway.

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  • A quick question to the anonymous pharmacist - why do you spend your time on GP massaging boards on Pulse? You don't seem to debate the subject, you just post about how GPs are overpaid and deserve what they get. What happened to you to make you hate GPs so much? You seem a pitiful figure.

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  • Regardless of whether the traditional model of partnership is more or less efficient there are insufficient numbers wanting partnership and the personal liabilities that go with it. The changes of the last few years are accelerating as younger GPs realise most of the property valuation gains have already been realised and they may well get left with it all to be sorted out

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  • 10:45AM
    "Any business has risk and liabilities."

    The problem (as I understand it) is that the GMS contract does not allow practices to be limited liability partnerships.

    Forming a limited liability partnership is normal in the rest of the business world and, as the name suggests, limits the personal liability of the business owners.

    Are pharmacies usually limited liability organisations? Or do have the same problem?

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  • Totally agree with 1145
    5 GPs working 70 our weeks for 110k as partners.
    Is much more efficient than 5 GPs working 38 hour weeks as employees for 70k
    OR 9 GPs working 38 hour weeks as employees for 70k.

    Speak to any junior doctor and the events of the last 12 months have changed how they view their role. Quite rightly they no longer have any sense of duty to the employer or NHS as a whole. When they become GPs and consultants employers will not be able to bully them in to working 60 hours in a full time role.

    People will look back on this time as an massive expensive mistake for healthcare in the UK.

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  • If you try and retire but can't find anyone to take over the burden ( why would they ?) then you will have to pay redundancy when the practice folds or carry on working.

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