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Gold, incentives and meh

LMC leader to chair Hunt review into 'reinvigorating' GP partnership model

The chief executive of Wessex LMC has been appointed chair of a major independent review of the partnership model to look into how it needs to evolve in the modern NHS.

Dr Nigel Watson, who is also a member of the BMA’s GP Committee and its former lead on commissioning, will oversee the review, which will report back to health and social care secretary Jeremy Hunt and NHS England chief executive Simon Stevens.

This comes as a Pulse survey of 420 GPs found that half of those who currently have partnership roles would consider giving them up to go salaried.

Mr Hunt first announced in Parliament in February that the Department of Health and Social Care was in talks with the BMA and the RCGP over a review of the model.

There is little detail about what the review will cover, and the Department of Health and Social Care has said talks are ongoing, but NHS England saif that it will 'help shape new options for future generations of family doctors'. 

Dr Watson has led GPs in the south of England for 14 years - he was previously described as an 'LMC legend', with Wessex LMC labelled 'the best LMC in the country' - and has been a long-time vocal member of the GPC.

He has also been leading attempts in Hampshire to open a 'multispecialty community provider', one of NHS England's 'new models of care' that will provide primary and secondary care.

Dr Watson said: ‘It is a great honour to chair the review and I plan to engage widely with organisations, as well as front line clinicians and practice staff, to identify the challenges and will make a number of recommendations about how the partnership model can work in the future.’

Health and social care secretary Jeremy Hunt said: ‘The GP partnership model has benefitted patients over the years but in an ever-evolving NHS environment we need to consider new ways to reinvigorate the current model.’

NHS England chief executive Simon Stevens added: ‘The great strength of British general practice has been its diversity and adaptability.

‘So in the year the NHS turns 70, this review will help shape new options for future generations of family doctors.’

GP leaders have previously warned that the profession will be staffed by salaried-only doctors in the future to the detriment of patients.

BMA GPC chair Dr Richard Vautrey said the GP partnership model 'is the foundation on which the rest of the NHS is built'.

He said: 'We know that our independent contractor status and GP partnership model are good for doctors, our staff, patients, communities and the wider NHS, but we also know that many practice partnerships are struggling to recruit new GPs as doctors raise increasing concerns about rising workload pressures, premises liabilities and indemnity risks.'

Dr Vautrey told Pulse earlier this year that there is ‘lots that we think can be done’ to modernise the partnership model, including providing flexibility for GPs working as partners.

‘That means keeping all that is best about the here and now, while also asking thoughtful questions about how the partnership clinical, business and career model might evolve for the future.’

This comes after Mr Stevens said in a hearing with the Lords committee in December last year that GPs were willing to consider ‘radical’ changes to their model of practise because they have been ‘systematically under-invested in’.

Meanwhile, shadow health secretary Jonathan Ashworth told GPs at Pulse Live in March that non-partnership models needed to secure future of general practice.

The Pulse survey asked GP partners whether they would consider going salaried 'if offered the right deal' with 50% saying yes, while 40% of respondents said no and the remainder said they didn't know.

This marks a marginal improvement compared with a Pulse survey carried out in 2016, when 51% said they would consider a salaried position and 36% said they would not.

GPs being pushed out of partnership?

As a Pulse analysis outlined in 2016, NHS England’s Five Year Forward View is quietly driving a move among practices to hand back their contracts, with GPs willing to work in salaried roles for foundation trusts, GP federations or under the ‘new models of care’.

As for the future of the small business model, NHS England announced plans to incentivise all GP practices to work in networks covering 30-50,000 patients.

Meanwhile, a Pulse survey last year found that just one in five GPs think the partnership model will exist in ten years time.

Furthermore, over half of partners have said they are willing to consider a salaried role if offered the right deal.

Readers' comments (28)

  • Peter Swinyard

    Inspired choice to lead this review. Let's hope that it reports swiftly and recommendations are implemented in full.

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  • Not without full consultation peter. Im a young GP partner and we are managing well at present by engaging with the wider cluster and working with other partners. Unilateral chanbe could be damaging

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  • More of the same amalgamating and federating then.Not really a rv of partnerships more of the smae BS.

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  • Nhsfatcat

    As long as the chair is not imposing his views first and foremost. We need to hear from the young GPs like James Weems as they are the future. Experience counts and we also need to help older GPs stay in the profession but we risk losing more ‘GP years’ by alienating the young.

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  • Took Early Retirement

    So, Nigel will end his career with a gong, (which some might say he deserves) but reading the above, I think it is just kicking the can down the road a little.
    I wonder if Ladbrookes will offer me odds on nothing much changing?

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  • A white British man nearing retirement. What better representative for a nostalgic resurrection of the dead horse of partnership? Visit a GP training scheme in a big city outside London and see how many white British males are in those groups. No-one in their right mind can afford to take on the financial and personal health risk of partnership. Those who remain will fight on in the trenches until they drop.

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  • It's not the partnership model that is the problem it is the outdated capitation model of funding that needs to change to a model that better reflects activity. Then and only then will Primary Care be sustainable.

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  • how about a new idea - pay each partner for the responsibility of being a partner. You could call it a Basic practice allowance!!

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  • David Banner

    Money talks and BS walks. Both partners and salaried GPs face intolerable pressure that has documented to death in Pulse, but if you want younger GPs to invest in partnerships then you have to ensure it is more profitable than salaried. With profits plummeting and responsibility rocketing, nobody in their right mind would take on a partnership.
    We need a guarantee that leases will be paid off, CQC will be abolished, and a boost in income. Assuming this is NOT going to happen, then please, please, please put us out of our misery and buy us all out, because the chaotic collapse of partnerships is destroying lives of both partners and patients.

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  • There is nothing actually wrong with the partnership model in's just that it has been willfully starved of resources for the past 15 years by the DoH to extent that younger GPs now (quite understandably) don't want to become partners any more....but now we need a review into why that is and what can be done to reverse the siutation...err I just told you in one sentence!

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  • AlanAlmond

    “Zero Tolerantz | Locum GP11 May 2018 10:38am

    A white British man nearing retirement“

    What exactly is your problem with white British men? The country in which the review he is leading is Britain, and the population in that country is predominantly white. Your comment is simultaneously racist and sexist. You call your self ‘Zero Tolerantz’. Who’s tolerance might that be? You are a bigot, but you think your particular bigotry is ok. No it isn’t.

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  • The review should not be done by one of the pale male and stale old guard.It should be done by the new breed who realise 9.5 session is undo-able in the current climate and control their work life balance themselves.The establishment who this guy represent are the cause of the collapse of the partnership so this review done by part of the establishment is done for it agenda.A waste of time and money.Primary care has been abused and starve of resources end of.

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  • I feel the biggest threat to the partnership model us uncertainty. Why would you take on all that risk when the government can squeeze practices and `let them wither in the vine`.

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  • Took Early Retirement

    I don't doubt his bona fides for one minute, but TOTL nails it; NW has been part of the GPC/BMA operation for ages; decades probably, which has achieved nothing for GPs and, some might say, been part of the cause of our destruction. It will not achieve anything.
    What is needed is a BIG pay rise, and a limit on workload, like a figure for how many consults a day is safe and desirable.
    I totally agree; payment for workload is needed. No one has ever properly looked at this. Payment per consultation, be it by email,phone, face-to-face or home visit is needed.

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  • It should be coalface partners saying what will keep them in place and salaries saying what will tempt them to take on partnership.
    I think there is some strong bargaining power to be used.
    After all someone needs to carry the can !

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  • I want:

    a) indemnity paying. The plan as I hear it is currently is encouraging.
    b) funding to allow GP's to change organisationally without bankrupting themselves. Legal fees etc are quite steep and are a block to proper organisational change.
    c) Most importantly - the right to sell goodwill. This will bring Primary Care investment by the 1000's of million.

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  • I have worked with Nigel and he understands and supports general practice with an enthusiasm that is rarely seen.
    Great choice. His ability to listen to all is brilliant. He may be white- not much he can do about that?? I for one am happy to be involved in the discussion- the more the better- will give a fair view of where WE think this profession is going.

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  • This article has produced some very interesting comments. I agree with the three main themes put forward:

    Any review must focus on the aspirations of younger colleague - who are predominantly female and /or second generation members of 'ethnic minorities'.

    At the moment it is very difficult to see why anyone should want to be a partner.

    The capitation system (plus ever-changing moronic bolt-on payments) has worn GPs out - the longer that it is preserved the more hopeless the outlook is for primary care in the UK. Many doctors with 'get up and go' are getting up and going.

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  • doctordog.

    The partnership model is an anachronism.
    Make the renumeration of salaried equivalent to this and the problem is solved.
    Let’s be honest, it’s all about the money really.

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  • Hunt imposes a penance that starves GPs, cuts NHS funding from 12 to 6.5 % , exposing the risks of Partnerships. Capitation fees mean added work that is unpaid and limitless. Consultation rates doubled in 18 years. Last man standing etc.
    Read Phil Peverley's agonising columns on this problem.
    Partnerships in its current form are open to abuse and sudden penance and strangulation from health secretaries, willy nilly.
    I would not even remotely recommend this, if ever you wish to get out quickly.
    Remember, what Hunt did once he or another can do so again.
    That is why we have thousands of Partnerships in complete distress needing Resilience money, as admitted by NHSE.
    A GP seeing 40 patients a day should not need resilience money, if he were paid per Consultation and not Capitation in Partnerships.
    To me on a personal level, I, like Phil, find it a form of abuse.
    That is why GPs are leaving.

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  • Alberto and Zero Tolerantz are just some of the reasons we are in this sh.. together. Other reasons being competition, jealousy, greed, salaried v partnership, ego, young v old.
    Govt knows how united we are !

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  • Title should read ‘ how to kill the partnership model cause it’s about freaking time!’

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  • Bob Hodges

    The partnership is the only reason we're not currently arguing the toss over the wreckage of a post-NHS reality already.

    It is fit for the future already assuming fair funding and less abuse from the NHS monopsony.

    It could be tubocharged with some organisational change funding, funded indemnity for NHS work, access to goodwill and genuine opportunities to provide services that are currently delivered at great cost (and indifferent quality) in an IT-lite manner by secondary care (that don't actually require a big building with beds in it).

    We've taken a few steps down this road with our recent merger. For example our 2 branch surgeries will be owned by the partnership and not individuals, with their capital value earmarked against wind up costs in the unlikely event of last-man-standing. There is also no need for buy in or buy out of partners. The lower bar for partnership has already helped us to recruit.

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  • Just Your Average Joe

    Simple truths - the vast majority of new trainees coming out from VTS are female.

    Even the small number of male GPs produced want to work less than full time.

    None of them want to work full days slogging from am to night.

    They want to do a max of 3hrs am, 3hrs pm and no visits. Most of our female colleagues with children would like to work around the school day, to allow pick up/drop off and see their offspring.

    If you get a salaried post - they want BMA contract limits on workload and home - with none of the limitless access cover required by partners.

    If as limited workload and hours locums and salaried doctors, earning pretty much the same as partners, there is no incentive to slog yourself to the limit and take all the responsibility, patient demands and general crap from NHS England, DOH and CQC etc.

    GP partnership will be dying from chronic starvation of funding, removal of incentives to be a partner, and the constant efforts of sucking out any profit from the contract, while increasing costs, and failing to fund new work adequately.

    I love partnership, but see the difference in workload and it is not sustainable, nor is it easy to recruit replacements for those who are leaving.

    Large basic practice allowance a starting point, for those willing to take on responsibility and workload for being a partner, and then the tide may change.

    Otherwise a work to rule salaried service, where costs will be hugely increased is the inevitable result, and that financial burden will be less than the required increase to make partnership sustainable.

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  • Just Your Average Joe

    If a basic practice allowance is hard to re-swallow:

    Start by paying all indemnity for partnerships.

    Then add a resilience payment for taking all the crap.

    Add a continuity payment - for taking ongoing responsibility for patient care.

    Make a premium for being a partner above and beyond locum/salaried - then the financial swing will move recruitment towards partnership and a sustainable primary care model.

    Fund per contact and capitation, not an unlimited access model - otherwise there will be no GPs left to see them.

    Remove Home visitation responsibility as the growing elderly population will have no-one left to see them once partnerships die - a centralised CCG service instead.

    PS ban on-line vulture services - sucking out funding from practices - destabilising them to point of collapse.

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  • I can tell you the result now. The future is more Working at Scale. The model of 4-5 GP, 10-12k patient practice* is out-dated. More virtual consultations. More specialists in large practices, some co-located with hospitals.
    We are walking away from the most cost-effective model (in the long term) of delivering primary care* and best use of limited secondary care resources.

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  • Partnership will never die but it will only change shape.
    The small partnerships will disappear and the big partnerships will get bigger, keeping up with the current trend of "the rich get richer and the poor get poorer."
    The vested interests of the SUPER partners will see to it.

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  • AlanAlmond

    Casual racism and sexism is ok on PULSE. So long as it directed towards the right type of people. We don’t want white men involved in general practice apparently. We don’t want white people (pales/stales) generally. Do we want a general practice work force in the future with no men at all? Are we looking for a primaryschool teacher kind of scenario? Has ZeroToleranz paid any thought whatsoever as to why white men aren’t choosing to be GPs? Is this a good thing? I make absolutely no excuse for pointing out the rampant hypocracy of so many of the posters on this site. If this man were Asian and I had come on here and said...another politically correct ‘brown’ guy I would have had my post deleted. I expect nothing but criticism from a self selected group of moaning bigots but if you think some how your kind of predudie is justified on account of your self identified victim status, I’d like point out two wrongs still don’t make a right. I’m done with PULSE. Good riddance maybe, but I’d suggest a wide range of views in a debate is healthy. When you all sit around agreeing how right you all are, you can be certain of one thing, you are most likely missing something significant.

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