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Why I'm swapping my portfolio career for partnership

Dr Mike Smith explains how finding the right team convinced him to join a partnership after years developing a successful portfolio career

Dr Mike Smith

In a recent conversation with long-time GP partner (and former NHS Clinical Commissioners co-chair) Dr Steve Kell, I found myself explaining the reasons I have avoided the partnership model for most of my career. This was mainly about flexibility and the ability to innovate outside of a practice.

Steve told me that when you find the right group of people, who share your values and you can work with within a trusting supportive environment, then GP partnership can be the most rewarding job a person can do.

Steve Kell is an impressive chap. He is also quite persuasive in his arguments about the strengths and models of general practice, which is hardly surprising given what he has achieved in his career. But I have to say I was sceptical, despite having reservations about some aspects of my portfolio career.

Over the past few years, like many of you, I have sat in meetings where various NHS ‘celebs’ have told us of the value of new models of care. I remember one of the New Models Team saying to a room of Camden GPs: ‘Tower Hamlets is going to blaze a trail for you, so that it is easier for you to adapt in the future.’

If we were paranoid, we might even think health leaders were trying to undermine the partnership model

Someone else later that day said to the room: ‘For nearly 70 years, you GPs have been the bedrock of the NHS, but now it is time to evolve.’

One of the final speakers of the day reiterated this sentiment by saying: ‘The days of a family doctor seeing patients whilst sitting in their house, paid for by the state, are over.’

Nearly all the think tanks, boffins, health commentators and ‘leaders’ when speaking of the future NHS seem to be supporting this view. Of course, they always acknowledge the role that general practice has to play in the NHS. Words such as ‘jewel in the crown’ and ‘bedrock’ are often used.

However, there are undertones of the need to alter the contractual model of our profession. At a drinks reception after a conference, one ‘celeb’ leader told me, we need a way to ‘round up the shopkeepers’ to reduce the variation and waste. If we were paranoid, we might even think they were trying to undermine the partnership model and make us all part of a salaried service.

Working as a locum has given me a perspective of the range of GP practices out there. I have worked in some that I have vowed never to work at again, and at others where I have become part of the furniture.

What is also clear is the impact of underinvestment on workload, workforce and premises. Morale is down, income is down, staffing is thin. Yet incredibly, staff still go the extra mile to see that none of this underinvestment hits patient care in any way.

There is anxiety out there, but it isn’t around STPs, ICSs, ICOs and so on. It’s about whether a nurse will leave for a different job, whether the senior partner will retire or how the practice can’t afford to give a pay raise for the fifth year in a row. But everyone does their best to ensure that none of this impacts on our care for patients.

However, as I continued from one place to another, I realised I was impotent to try to help practices implement the skills and tricks I have learnt (and copied) over the last ten years. I also felt that when teaching, lecturing, mentoring or consulting, without a base, I lacked a little credibility.

Then, a couple of months ago, something magical happened. I did a locum in a practice that I fell in love with at first sight. From day one, there was an aura of friendliness. A feeling of teamwork and, most importantly, a really wonderful stable partnership with a team of GPs I instantly warmed to and respected. All different, but with highly complementary skills and personalities.

There was a desire to do things different. To innovate. To want to be better. It was a big practice, with a really good sense of community. Steve was right. Partnership was calling. And, as luck would have it, there was a Mike Smith shaped space in the team.

So, from 1 June I am to be the latest partner to be appointed to the Maltings Surgery in St Albans. I am very excited about this. With my colleagues, from our own community and space, we are going to preserve the values of the family doctor, innovate to make the job more rewarding and make it one of the best practices to work in England. It’s not a new model of care, it’s simply updating and renovating a tried and tested model of care, that is literally keeping the NHS afloat at the moment.

Viva la partnership!

Dr Mike Smith is a soon-to-be GP partner in Hertfordshire



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Readers' comments (9)

  • Brave or stupid ,mmm,admirable wish you good luck.But it feels like the tide is against us.

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  • David Banner

    Well, St Albans ain’t St Helens, so maybe there are still pockets of paradise out there, but for most of us the jig is up, recruitment is a joke, burn out is driving us out, and to quote Private Fraser, “W’are doooooomed!”.
    But I wish you every success nonetheless.

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  • I have been a Partner for 8 mths after several years of moving about/locum/findings feet. For me it has been all about finding the right team with a great sense of humour. I feel more settled than ever and despite the obvious pressures I feel the rewarding areas are worth the stress at this time. Best wishes.

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  • It’s great to read this positive story! I wish you and your team well .

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  • Well done Mike. Tide might be turning...
    Not enough being said about how great partnership can be to us youngsters (certainly not from course organisers)

    Autonomy to innovate
    Longer deeper team relationships
    Usually better income
    Get to know your patients and their families
    Not to mention, state gifting you a share in a building if you own

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    ETC ETC.



    ANY ANSWERS????????????

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  • AlanAlmond

    I completely get where you are coming from. Having been a Locum for a number of years (interspersed with a couple of dire salaries jobs) whilst I enjoyed the freedom of being a locum, the more experienced you get, having never been a partner, the more frustrating it becomes that despite your experience you never get an opportunity to give it back and shape the future. I can quite understand that if you find the right practice a partnership might feel like the right thing. Alas I don’t believe this alters the sad reality that ‘the system’ doesn’t agree with you, for all the reasons you list in the preamble to you decision. Those running the NHS don’t believe primary care as it is should continue. That isn’t going to change because you’ve found really good colleagues and a nice practice. I wish you all the best I really do and I’m sure you’ll do very well but the bigger picture isn’t so rosey and the other option , when you feel you’re not progressing and frustration rises as a more experienced GP doing locums , is to leave the profession rather than take what used to be the next logical step (partnership) but sadly no longer is.

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  • Great prose and I admire your tenacity.
    There is a lot to recommend being a GP partner, the job really can be what you make it. Many in this forum are (probably quite rightly) cynical. Doesnt mean you have to be.
    At some point it will and must change.
    I wish you the best.
    Would you consider an update in 6, 12 , 24 months?
    Would be of great use to all behind you considering similar steps.

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  • Mike, your new practice looks like around 14 GPs and mostly part-time and 7 sessions being the max anyone works. Can you you tell us if the building has a 'PFI'-type 'millstone' lease? This is a huge issue for smaller practices like ours with partners in their late 50s.

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