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Ministers must look at premises problem

Dr John Couch believes that, after a massive dip in popularity, partnerships are making a genuine comeback

For several years becoming a GP partner has been out of favour among younger GPs.

Locum work or salaried posts have been favoured instead.

However, during the last year, many areas have seen an increase in partnership applications.

It seems that partnerships are coming back into fashion. But why the change?

Many of the reasons have been generated by the new contract and a major factor has been the ability to opt out of out-of-hours cover.

Although pre-new contract large numbers of practices were paying deputising services or co-operatives for out-of-hours, bottom-line responsibility still rested with the partnership.

For example, during 2003, Healthcall decided to pull out of several areas with no prior discussion and little notice.

This left practices to cover the 118 hours between 6pm-8am Monday to Friday plus all weekends. In some cases this occurred shortly before Christmas, disrupting many GP seasonal breaks. Most practices have opted out so such responsibility now exists for the vast majority.

New partners can rest assured that their only out-of-hours contact with patients is by choice. Interestingly many GPs now exercise that option by working co-op sessions.

Greater flexibility

Over the last 10 years the number of female GPs has risen dramatically, more than mirroring the increase in medical school female/male ratio.

Female GPs are more likely to want part-time work and flexible hours in order to fit in the needs of a young family.

Coupled with this has been the increasing vogue for a portfolio career among both sexes. It is therefore not unusual for young GPs of both sexes to have two or more jobs in parallel.

As always practices faced necessity and adapted to this new breed of GP. Initially, in the years when it was

often difficult to recruit partners,

part-time salaried GPs were the only choice.

Now we can see that it is perfectly possible to adapt to GPs who want to start work later, go home earlier and only work three or four days a week. This has also spilled over into partnership posts.

As long as roles and responsibilities are carefully defined in the practice agreement, rancour is unusual.

There are now few practices left with a 100 per cent full-time GP compliment.

Indeed many older GPs have now taken advantage of this change in attitude and reduced their hours as a prelude to retirement or to bolster a flagging morale!

Reduced buy-in obligation

Around half of all practices own their premises. Historically most of these have been owned equally by partners, the ethos being to bind partnerships together in a positive way. It is also an excellent financial deal in most cases.

In recent years buying in has been viewed with much more negativity by younger GPs.

One reason, the large financial commitment at an early and high expense career stage, has always been present. The other, a greater tendency to change jobs, is more recent. This has added to the difficulty in recruiting partners.

Once again partnerships have adapted. Some have sold up and moved into PFI premises. Other property-owning partners have initially been forced into buying shares from retiring or leaving colleagues.

It is interesting that what was initially seen as a grim necessity is often now seen as a business opportunity, fuelled by rent reimbursement.

In most cases a positive income return takes little or no time from purchase and if only one or two partners eventually own the premises they can always sell up.

But in fact few practices now insist that a new partner buys a property share. So this seems a win-win situation for all concerned.

No more jobs for life

For the reasons above, coupled with the relative ease in finding new posts in the last decade, fewer younger GPs see themselves staying in one post for their whole career.

Traditionally a partnership has been seen as a long-term commitment. This view has been subtly changing for some time.

While no partnership wants changes every year, there is an acceptance that partners may move on after a few years. It is better to have a high-quality partner in the medium-term than a succession of locums and salaried partners who are less likely to reach peak efficiency in the generally shorter time that they stay.

Both new and existing partners

now seem to share this view and partnership agreements rarely make it difficult to leave, although notice periods for partners of around six months tend to be longer than those for salaried GPs.

Greater variety

There is little doubt that the variety of both clinical and non-clinical work available is generally greater for partners.

After a year of two as a salaried GP many young doctors become a little bored of a diet consisting mainly of consultations and visits. There is little doubt that life as a partner is rarely boring, either clinically or non-clinically.

While some GPs are happy to avoid non-clinical work, many find that running a business is actually exciting and stimulating.

The current crop of younger GPs is no different. Having built up experience and confidence clinically, many now want to stretch their business and administrative muscles!

Image of partnership

Finally the image of partnership has changed for all the above reasons. Partners are no longer tired, demoralised and stressed.

They have more flexibility, shorter hours, more job variety and more money. Partnership is at last more attractive once again.

Indeed this change has gone one step further. Practices with several salaried GPs are now common.

With this experience many practices now choose to replace a partner

with a salaried GP, not through necessity but for cost-effective business reasons.

Indeed there are plenty of salaried applicants to choose from now that successive cohorts of younger GPs have shunned partnerships for so long.

Fewer on offer

We now even have the paradox that there are more applicants but fewer partnerships offered.

During the golden years of the 1980s it was common to get 60 or more applications for a partnership; I suspect it will not be long before the same phenomenon occurs.

John Couch is a GP in Ashford, Middlesex

Financial imperatives

Probably the greatest stimulus for the increasing numbers of partnership applications is the income gap opening up between salaried GPs and partners. The financial pendulum is undoubtedly swinging back on favour of GP partners.

For many years one of the major arguments for becoming a salaried GP was 'As a salaried GP I can earn almost as much as a partner with fewer hours, less stress, less financial commitment and more flexibility'. Up to two years ago, if I were a newly-qualified GP, I would almost certainly have chosen to do locums or apply for a short-term salaried post.

The new contract has changed that. Partner incomes are rising to a level consistent with greater experience, workload and financial risk. This will become more apparent by the time accounts for 2005/6 reach the press but is already common knowledge.

NHS pensions are also affected. Partner pensions are now based on superannuable NHS profit. Final pensions for partners will be higher than those for salaried GPs.

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