What to look for in a GP partnership

The early 2000s boasted some trends which will probably never come back into fashion: camouflage trousers, double denim, and rhinestones, to name a few. What younger readers may not realise is that, for a few halcyon years, being a GP principal was a pretty good deal, and partnership vacancies were hotly sought-after.

Sadly, years of neglect and underfunding have made UK primary care a difficult place to be, and most young doctors finishing their GP training today find partnership an unappealing prospect.

However, if you get it right, becoming a partner can be enjoyable and financially rewarding. GP trainees often report that their registrar years have left them feeling ill-equipped for partnership, but, if you find the right team, you’re likely to find it at least as supportive as a salaried job – and, thanks to the continuity, probably more so than locuming.

Partnership is a huge commitment, and, to extend the clothing metaphor, you need to be sure that you’re investing in something with timeless appeal, rather than something which looks good today but which will lose its lustre quickly. It may not be fashionable, but if you’re brave enough to stand out from the crowd, here are some tips to help you find the perfect fit.

1. Do you like the partners and do they respect you? This is the most fundamental point of all. The old adage is that a partnership is like a marriage, and getting out of one is harder than divorce. That’s not quite true these days, and people leave partnerships for all manner of reasons, such as geographical relocation or a change in personal circumstances. However, a partnership is often rather like a family – you’re in close proximity to each other for a long time and need to be able to rub along. You need to have a functional working relationship and to be able to respect partners’ opinions even if you don’t always agree with them.

So, if you’re interested in a partnership vacancy, try to meet all of the existing partners before you accept a job offer and remember the deal cuts both ways: do you get the feeling that these people respect what you can bring to the table? Don’t fall into the trap of assuming that you should be happy to be treated as a ‘junior partner’ because of your age. Although you will, no doubt, cede to your more experienced colleagues’ wisdom on occasion, your opinions should be no less valid than anyone else’s once you’ve joined the partnership, and you should be expect to be involved in decision-making.

2. What is the working day like? As I have previously warned, some GP surgeries perform egregious feats of propaganda when they have a vacancy. They will tell you that they never see any extras, finish at 5pm on the dot when they’re not on duty and at 6.31pm when they are, and that they pop home to watch Neighbours over lunch after the one visit they have each day. To get a true insight into a practice’s working day, check the appointment screen. How many patients will you see in a typical morning or afternoon session? What is their policy on extras? How many phone calls will you be expected to make, and will you have dedicated time for them? How many visits are there on a typical day? When do the partners do their admin? Is remote access available so you can work from home, and if so, is there a culture in which GPs are expected to work when not physically in the surgery? How is on-the-day demand managed? If there is a duty system, what is the on-call GP expected to do, and are they supported by another member of the healthcare team, like a nurse practitioner?

You may become frustrated if you are working with partners with a radically different attitude towards unfunded work

You will also get a sense about workload during your visit – is the reception area a chaotic stampede of patients demanding to be seen immediately, or do you get the impression that everything is under control? If possible, it can be helpful to visit more than once, at different times of day and on different days of the week. As a partner, you must expect to work hard, but you should not take a job in which you will be expected to work unsustainably; that is a recipe for burnout.

3. How ‘resilient’ are the partners? In line with the approach championed by the excellent forum ‘Resilient GP‘, a ‘resilient’ partnership will resist the transfer of unfunded or inappropriate work into primary care. If a patient comes in immediately following surgery, saying that their hospital consultant told them to get their post-op sick note from their GP, a resilient GP won’t say: ‘Of course – how long?’; instead they will politely but firmly insist that it’s the surgeon’s job. In reality, most doctors sit somewhere in the middle, but it’s important to make sure that your own personal stance isn’t too far divorced from that of your potential partners, lest resentment develop.

You could check if there is a practice policy on non-NHS ‘notes from the doctor’, like housing letters and parachute forms. What does the surgery’s prescribing data look like? A partnership with a tendency to hand out antibiotics too readily will create work for itself, as minor illness becomes medicalised and patients learn they must see the GP with every trivial symptom.

Although life would be dull if all GPs were the same, you may become frustrated if you are working with partners with a radically different attitude towards unfunded work.

4. Do the numbers add up? Don’t be too shy to ask about money when you go to visit practices. Although you are unlikely to be shown the accounts until you’ve been offered a partnership, you can expect some basic information earlier in the process. It is reasonable to ask about typical drawings (this may be expressed as a full-time equivalent which you will need to adjust if you plan to work part-time), the value of their premises, and the cost of any buy-in. Some prospective GP partners are nervous at the prospect of raising a mortgage to buy into a building. However, given the steadily climbing rents and service charges faced by many partnerships which lease their premises, joining a property-owning partnership may be a sensible choice. You may also wish to check whether the property is owned by all of the GP partners, or just some of the team; if all of the partners have a stake in the building, this should make the organisation of maintenance and repairs more harmonious.

5. Would you be happy working in that setting? Is the building pleasant? Does the architecture suit you – and is it fit for purpose? Some GPs enjoy working in modern, purpose-built premises, while others find them sterile and claustrophobic.

Some doctors prefer a converted house, while others are irritated by irregularly-sized rooms and tortuous corridors. One surgery I visited had a huge window in the first-floor meeting room, overlooking glorious rolling countryside. The prospect of practice meetings spent gazing at that view was almost enough to get me to sign up on the spot.

Of course, it’s also important to consider the wider setting – for example, if you want to serve a certain demographic, such as students or an inner-city population.

6. What’s the deal on offer, and is it negotiable? It’s important to realise that the process of joining a practice is a negotiation. If you are unhappy with the terms offered, it is reasonable to discuss, politely and constructively, whether or not they are set in stone.

The most contentious issue is the concept of ‘time to parity’: the idea that an incoming partner has to work for a set period of time, typically anywhere between one and three years, before receiving a full profit share. It’s an employee’s job market at the moment, and many surgeries are struggling to recruit, so it is common for a new partner to start on full parity after their mutual assessment period. If you are asked to wait several years for parity, you may wish to negotiate.

Savvy surgeries have found ways to ensure that their GPs are doing only the work that needs to be done by a doctor

7. What is the wider team like? It’s not just the otherdoctors you’ll be working with. Does the wider team seem cohesive? Is there a high turnover of staff, with the associated recruitment and training costs? In a happy surgery, you should get the sense that staff members have a sense of ownership and are happy to take responsibility for their work, while feeling able to ask for help when needed.

8. Do the partners use the whole healthcare team resourcefully? Primary care is a difficult place to be at the moment; many surgeries are unable to recruit a full complement of GPs and are operating with a chronic doctor deficit, and GP workload seems to increase every year. In this climate, savvy surgeries have found ways to ensure that their GPs are doing only the work that needs to be done by a doctor. Many tasks can be delegated to other members of the team. With training, administrative staff can be taught to use protocols to filter document workflows, ensuring GPs only see letters which require a doctor’s input. Some surgeries have had great success using practice-based pharmacists to reduce the burden of medication reviews and prescription reauthorisations. If the surgery you are looking at does not already use the wider healthcare team in this way, ask how they do manage workload, and how much time partners typically spend doing admin.

9. What are they looking for, and are they open to change? It is important to try to gauge what the existing partners are looking for in their new colleague. Do they just want another body on the ground to see patients, or are they looking for a fresh perspective on strategic issues? If you are brimming with ideas about how to improve patient care or the doctors’ working lives, you will become frustrated if your new colleagues are resistant to consider change. Are there any particular clinical skills they want their new applicant to have, such as the ability to fit coils or perform minor surgery? As a newly qualified GP, you may not have any additional skills or special interests yet – would you be happy to develop a skill the partnership has a need for?

10. What do other people think about the surgery? Although the CQC are much-maligned, their reports do provide a useful external perspective. For example, if there are tensions within the team, this may be picked up on in the section of the report which looks at whether the practice is well-led. You may also be interested to look at the surgery’s performance in the GP Patient Survey. If there are significant problems with appointment availability, or the performance of reception or clinical staff, it may be reflected in the results. If you’re looking for a job in the area in which you trained, ask your trainer, the other registrars on your VTS scheme, and any other GP friends about what they’ve heard about the surgery. My job-hunting was complicated by the fact that I was relocating, so I did not have local contacts with whom to discuss prospective workplaces. Nevertheless, I gleaned some useful insights simply from exploring the local area and talking to members of the public. Estate agents and shopkeepers will often let slip their experiences of being a patient at a surgery if you mention you are considering working there. Although one single piece of negative feedback shouldn’t put you off, a wider pattern could be a warning sign.

Dr Heather Ryan is a GP in Derbyshire and outgoing RCGP North West AiT committee deputy lead. You can follow her on Twitter @DrHFRyan and view any conflicts of interest here.

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