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A faulty production line

Only one in five GPs thinks partnership model will still exist in ten years' time

Exclusive Almost two-thirds of GPs believe that the partnership model will not exist in ten years' time, while only one in five believe it has a long-term future, a Pulse survey has found. 

The survey of nearly 850 GPs comes as a House of Lords committee this month said that the traditional model of general practice is 'no longer fit for purpose' and the Government should explore a future where GPs are under its 'direct employment'.

GP leaders told Pulse that partnerships will only survive 'in isolated patches', due to ongoing pressures and future liabilities on practices, include increasing legal claims.

The survey shows that 57% of GPs think the partnership model has no long-term future, compared with 53% at the same time last year.

It comes as Pulse reported this week that the partners at four practices in Gosport, Hampshire, have agreed to move to salaried posts working under the local hospital trust.

The partnership model has been under debate after the House of Lords Committee on the Long-term Sustainability of the NHS, set up in May last year, said that the 'small business model' of general practice is 'inhibiting change' that is necessary to put the NHS on a sustainable footing.

It cited comments made by RCGP chair Professor Helen Stokes-Lampard, who told the committee: 'Whilst personally I love the partnership-led model of general practice, I know it is not likely to be fit for the long-term future.'

However, the college later clarified the comments, with Professor Stokes-Lampard telling Pulse that she 'fully supports' the partnership model, but that the model needs to adapt to new plans for integration being developed by NHS England, which will see organisations providing primary and secondary care. 

Respondents to the survey said that, despite Professor Stokes-Lampard's belief that the partnership model will continue, younger GPs have little interest in taking on partnerships.

Family Doctor Association chair Dr Peter Swinyard told Pulse that it will only exist in 'isolated patches. He added: 'There are so many pressures and future liabilities on practices in this litigious age that traditional partnerships [are] unlikely to continue'.

He added: 'The majority of new GPs do not want the extra responsibility and admin work of being a partner at a time when they can often earn as much as or more than the partners in the practice.'

However, he added: 'With the loss of this model may go a loss of continuity of care and the feeling that patients have of their “own doctor” who looks after them for a lifetime. I have certainly had many of my patients for more than 30 years.

'This is a great sadness as the partnership model has served us well for half a century.'

Dr Rob Hendry, a GP who has emigrated to work in Western Australia, having previously worked in East Cheshire, said 'no matter what Government', they will want a salaried GP workforce 'as they would have more control' and could 'pay us less for more work'.

Do you think the partnership model of general practice will exist in 10 years' time?

Yes - 20%

No - 57%

Don't know - 23%

The survey was launched on 3 March 2017, collating responses using the SurveyMonkey tool. The 28 questions covered a wide range of GP topics, to avoid selection bias on one issue. A total of 846 GPs answered the question above.

Readers' comments (23)

  • What do we think will happen to property in the event of a salaried service?

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  • whatever, but they will realise their great mistake when the cost of a salaried service starts to add up. Same as out of hours.

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  • Oh well looks like i might decide to retire earlier than expected.

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  • When the 2004 cohort go no GPs at all.

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  • AlanAlmond

    The currently partner model is apparently no longer 'fit for purpose' - what we are aiming for is a more expensive (but very easily controlled) primary care service with no continuity and hardly any Drs then ..that's what the 21st Century requires is it? That's what these genius's in the Lords have in mind? Or is it really they don't have a clue what the reality of a fully salaried service would be. More like. Partnerships aren't working because the service is massively underfunded. Making structural changes which will in fact make the whole system less responsive to local needs and MORE expensive is bonkers. But of cause it will happen. The survey simply reflects passive acceptance of a political inevitability ..don't mistake it for a vote of confidence in this stupidity.

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  • I love the partnership model but the general trend now seems to be against it. Ten years is a very long time and much can change. Unfortunately it will be continuity if care and the patients will suffer.
    Whatever happens you can guarantee that if it costs more or fails the rhetoric will be ' lazy GPs who choose to opt out if the responsibility or caring for their patients' ' same as out of hours. They don't realise how good they have it till they loose it.

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  • A fully salaried service will simply push demand onto GPs using threats of GMC referral if we do not meet demand. If you walk away at the end of your day with unfiled results/patients to call back, they will just use regulatory threat to control you.

    Do not expect this to be your saviour. All they want is to deliver it more cheaply.

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  • I agree with hamster above. The reality of GMC and now manslaughter prosecutions makes batting things back as 'not in my contract' very difficult as a form of pushback. Once you 'see' a medical problem it is very difficult to 'unsee' it and this is the situation GPs find themselves in with 50 nicely typed and timely discharges/workload dumps arriving for each GP daily.

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  • everyone has a price your price to work as salaried! ... BMA model ~60k full time ?

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  • No BMA model 90K, and thanks very much

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  • BMA model 60K is nonsense-NHS Lincolnshire is giving Salaried Eastern European Docs 90K salaried...

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  • But apparently, a noctor or phoctor will (not sure can) do it for less.

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  • Lawyers are charging minimum £180 not including VAT.Most are above £200 Why are doctors underselling themselves?The free service is not appreciated. Did we all get Bs and Cs to get into medical school and the lawyers As?

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  • I think this is irrelevant.

    The NHS will not exist in a meaningful way in five years.

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  • Just Your Average Joe

    Most of the world is looking to take one of the most cost effective and well loved healthcare systems - UK primary care, as a way of operating in a world where private companies are making healthcare costs so high normal people will be priced out of accessing care.

    NHS is piece by piece being dismantled and prepared for a US market to come in and cannibalise the most lucrative areas, cherry picking the services where they can make huge profits, leaving the expensive and difficult areas behind.

    Large swathes of people will be unable to afford care.

    It is not too late, a small investment in primary care ( just a fraction of what will be thrown away on Wasteful projects like Trident), could fund a world class service.

    Return the basic practice allowance to incentivise partnership, but allow the skill mix to continue to allow choice in provision where recruitment remains tough.

    Cradle to grave care, needs doctors who work longer than the 40 hrs trainees are currently being herded into, so they can learn the job, and resilience needed to be a partner.

    Is is not hard to see that when locums and salaried colleagues can earn more than partners without the responsibility and hassle, that they decide to take a path away from partnership, that will eventually allow private providers to come in and employ doctors, pay peanuts, and make huge profits at the NHS's expense.

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  • Secure environments GP

    Only one in five GPs thinks partnership model will still exist in ten years' time

    They will be the GPs left without a chair when the music stops clinging on to a the partnership model to try and avoid some massive financial loss (eg property problem) if not.

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  • I am a CCG board member,I joined to try and save primary care but the money available to invest in 5 year forward view is tied up to new ways of working and new models of care. None of it apart from crumbs will go to GMS practices, Simon Steven's and NHSE are the enemy now. The irony is that he expects doctors will work as cheap salaried employees but they won't they will work as locums and set our own rates of pay in a sellers market as hospital doctors are doing and many of our colleagues.
    Everything in life comes down to terms and conditions and doctors no longer wish to work for the NHS we have more power than Steven's and Hunt realise

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  • Why would salaried GPs be any cheaper than a hospital consultant ?

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  • well I don't mind being salaried but 15k a session is probably the minimum that would make me sign up. Problem is many are anxious overachievers worried that they will be out of work or whatever and agree to work for low pay. They will be our downfall. If we don't all know our worth and demand it then we all might have to accept less.

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