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GPs buried under trusts' workload dump

Government 'serious' about retaining GP partnership model, says review lead

The Government and NHS England are ‘serious’ about reforming the partnership model to improve it for GPs, despite previous suggestions that it should be removed altogether, the head of the group reviewing the model has said.

Dr Nigel Watson said it was no ‘secret’ that some parts of the Government believed traditional general practice was a ‘corner shop model, and we should be put in the annals of time’.

But he said the head of NHS England and the health secretary had made it clear to him that ‘the partnership model still has value in terms of supporting the NHS’.

Dr Watson, a GP partner in Hampshire and chief executive of Wessex LMC, was appointed in May by the Government to lead its independent review of the partnership model.

His comments came as part of a roundtable event hosted by Pulse last month, which brought together GPs to discuss what changes to the model are needed.

At the event, which was held in conjunction with the Family Doctor Association, Dr Watson also revealed his thinking on the benefits of GPs working at scale – such as flexible working hours for GPs – but stressed ‘I don’t think superpartnerships are the only model’.

He also said that for superpartnerships to work, having suitable indemnity arrangements in place was ‘key’.

‘Working at scale, the issue is having a comprehensive scheme that covers everybody working in primary care. That would be hugely valuable for the system, let alone for us as individuals,’ he said.

Meanwhile, he suggested he was looking at the possibility of practices who hand back their contract to the NHS also being able to transfer the lease for the premises to the NHS.

But he suggested the arrangement was not likely to go as far as Scotland’s in which NHS boards are taking over all GP leases.

‘In terms of premises, I don’t think we’ll get to where Scotland has got to but I think there is an element of, if a practice with a 20-year lease hands its contract back, it isn’t responsible for the lease, so the NHS could take the responsibility,’ said Dr Watson.

Dr Andrew Buist – the deputy chair of GPC Scotland who helped to negotiate recent major changes to the GP contract in the country – attended the roundtable event and questioned whether the Government was serious about reforming partnerships in England.

Dr Watson said: ‘I don’t think I’m naive and if I thought it was all a charade I wouldn’t have agreed to take on the role.

‘I do think they’re serious but I don’t think there’s any particular secret that there are people in government who say that we are a corner shop model, and we should be put in the annals of time – such as in the House of Lords report last year.

‘But I can assure you that having met face to face with NHS England chief executive Simon Stevens and Jeremy Hunt, when he launched the review as health secretary, they are serious. They believe the partnership model still has value in terms of supporting the NHS,’ he added.

The House of Lords Committee on the Long-term Sustainability of the NHS published a report last year that said the traditional model of general practice was ‘no longer fit for purpose’ and the Government should explore a future where GPs are under its ‘direct employment’.

It said the ‘small business model’ of general practice was ‘inhibiting change’ that was necessary to put the NHS on a sustainable footing.

However, the RCGP said at the time that while GPs were open to new ways of working there was ‘no one-size-fits-all approach’ and that practices should be able choose the best way of working for their patients.

The organisation’s chair, Professor Helen Stokes-Lampard, said the independent contractor model ‘brings important benefits and must be nurtured and maintained as an option going forward’.

Readers' comments (16)

  • The NHS taking over leases would be a major indicator of trust in the partnership model. Leases are now a real obstacle to partnership for young doctors who are quite rightly frightened of being saddled with a lease without the stability and the promise of a future that previously existed in primary care.

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  • Allow LLPs and limited companies like the majority of other professions and/or cover the liabilities.If you dont increase funding and profits you will not attract partners.At the moment you are better off being a locus than a partner or salaried.If that is not addressed this is a non started of which we have had many over the last decade or so.

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  • Took Early Retirement

    Nigel is sadly being duped; it's HMG's way of kicking the can down the road.

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  • Nigel this really is Last Chance Saloon stuff,the next move from HMG/NHSE will be pivotable. We await all manner of incentives to keep going - indemnity,premesis are just two. All we have to date is one kicking after another, the hypocrisy from our SofS re the DDRB confirmed the reluctance to even attempt to address the issue! If you have any influence you really must ensure that resources come rather than platitudes. The Politicians really have to be held to account, you come across as someone of integrity just remember to let the Politicians know that they have no wriggle room left, we are not fools! Good luck!

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  • Nigel,

    As you are not naive, please let us grassroot,GP’s know....when anything you recommend or suggest is brought into fruition.

    We are tired of promises and I for sure cannot see light at the end of the tunnel.

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  • @turn out the lights

    Allowing LLPs to hold contracts seems such an obvious "easy win" to me (in terms of encouraging GPs to join partnerships) that I can't understand why it hasn't been done long ago. Is there a downside for the government in doing so?

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  • OK, shall we get one thing clear? If we have a viable model, then it shouldn't need 'incentives' to make it work. The very existence of 'incentives' (anywhere)is an admission that the basic model itself isn't fully working or even workable.

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  • Just talk. The Govt and NHSE still have no support for small partnerships. If they wanted small partnerships to exist they would have been bringing in the measures as outlined by others above.

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  • Took Early Retirement

    Isn't it an irony: I get better pay rises as a retired GP than I did when working!

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  • I’m only trying to help you he says with a wicked smile and a sword thrusting towards the heart.

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  • The rigid working pattern of being a partner or salaried GP mean that I won't ever return to full-time GPing. Locum Chambers offer peer support and some stability but most importantly flexibility e.g. I can choose 12-20 minute appts (unlike retainer scheme), work less in school hols, work during a school day, and then much more intensively some days/evenings to minimise childcare costs. I don't want to risk personal bankruptcy,so left before I was the Last Man Standing. I also want to minimise my indemnity by doing other non-clinical work and some non-NHS work. There's no point doing more clinical GP sessions if you pay a higher indemnity, higher pension band and overshoot your annual pension allowance. Look at profit per hour, not income, and the maths massively disincentivises partnership. The aren't just two options. Many GPs are making a personal choice to save themselves, after much sacrifice of their own health, and they will not be tempted back by either the Watson model, nor the salaried industrialised cog model.

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  • AlanAlmond

    Unless the suggestions come from someone with a degree in media studies/history or classics with work experience in local radio, publishing or PR any bright ideas will be dead in the water. No one gives two hoots what the Drs think, really why bother.

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  • I feel, sadly that zero toleranz is right. What is the incentive to become a Partner? You carry all the responsibility with no chance of influencing any health policy or strategy. No one higher up the bureaucratic tower ever [wants] to listen to the Grassroots. they only set up more quangos and authorities like CQC to kick you in the nuts when you haven't gold plated the last edict.
    I left as a Partner for these very reasons cited by zero. To save myself from insanity for a very modest pay drop. My only regret, should have done it two years earlier.

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  • HA HA HA here we go again, they really do mean it. They cocked up , they thought controling us by making us all salaried would be ideal, then they realised, sugar,its gonna cost a lot in admin to keep them going and doing all the other stuff we are not paid for. Lets keep the partnerships its cheaper and less hassle for us in the end.


    the evil sods thought , hang on, making them salaried will give them a unified power of equality and also we cant stress them out as much unless they remain self employed partners. God forbid GPs should stand up for their rights!!! . They need to see us suffer, why?? privatisation and suppression of the educated and respected, well not so sure about the last bit but you get the drift.

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  • There may be serious problems with the nature of the open-ended, poorly funded and unrealistic contracts imposed on GP partners. However, I think GPs would be naïve to think that accepting a salaried model would be better.
    Do you think you will have a model similar to hospital doctors? A word of caution: Many aspired to become consultants only to have their career in limbo as a ‘staff- grade’ (lower income, non-permanent contract ‘disposable’ doctor – not dissimilar to the GP hospital clinical assistant).
    Equally, who do you think will hold the GP contacts – NHS England – probably not.; it would be delegated to a company such as Capita – Their reputation as an employer precedes them!! Just as colleagues who have worked part-time for them doing disability assessments. The contract to employ a salaried GP workforce will probably be awarded to the lowest bidder. The said company will endeavour to make a profit from the contract for its shareholder’s, which will have to be achieved by reducing costs (GP salaries). If the contracts are so large, there would be few alternative employers so it would be a ‘take-it-or-leave-it’ scenario.
    Even if government gave assurances that the above situation would not arise, then we should be aware that mergers and acquisitions creating monopoly employers could arise further down the line. Equally, we are very used to GP contracts being re-written unilaterally and then imposed on us.
    Before ditching the partnership model, carefully consider whether you are jumping from the pan into the fire!

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