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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)

  • 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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