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GP partnership models could introduce ‘attractive features’ of locum model, says review

The Government's partnership review will look at how to reduce premises liabilities and how GP partners can work more like sessionals, its call for evidence has revealed.

The review, which is being led by Wessex LMC chair Dr Nigel Watson, will look at issues including workload, workforce, the role of general practice, the business model and next steps - and is asking GPs to submit feedback.

It sets out a number of 'key questions', including what general practice can 'learn from other industries and sectors who operate in a partnership model'; what 'local examples of good practice' could be shared more widely; and what role that 'digital technology and data' could play in 'supporting' the partnership model.

It also asks what GPs feel are the 'biggest burdens' in terms of workload; what are the 'barriers and motivations' to entering partnership; and how 'attractive features' of salaried and locum GP roles could be 'introduced into the partnership model to make it more attractive'.

On premises, it asks: 'Is there a way to limit the risk to partnerships holding a long term lease? How can the risk of owning a practice building be reduced?'

The review will also look at reducing 'the personal risk of employing staff, vicarious liability, and personal name and shaming of a GP'. And it will ask what are the barriers to GMS and PMS contracts being held by a limited liability partnership (LLP).

Dr Watson said: 'The review will examine the challenges facing the partnership model and consider how best to reinvigorate and equip it to help lead the transformation of general practice for the future. It is an honour and privilege to take on this role; however I do not underestimate the enormity of the task ahead...

'I strongly believe that the partnership model of general practice has not reached the end of the road. It predates the NHS and has evolved to support changing population needs, and will do so in the future. However, it is important to recognise that this model is not the only way to deliver care.'

Dr Watson said he will be 'travelling around the country meeting GPs and front line staff, practice managers, patients and others, to seek their opinions and collect views on what works and what doesn’t work' over the next 'couple of months'.

He added: 'I would encourage you to consider the key lines of enquiry and submit your views, or to come and meet us at one of our LMC events. It’s our future; and it is up to us to shape it.'

Dr Watson will be publishing an interim report 'in the autumn' and will report back to health secretary Jeremy Hunt and NHS England chief executive Simon Stevens 'at the end of the year'.

Key questions include

  • What are the features of other GP career models (e.g. locum, salaried GP) that are attractive to GPs? How could some of these features be introduced into the partnership model to make it more attractive?
  • Why is there currently a barrier to a practice contract (GMS or PMS) being held by a Limited Liability Partnership (LLP)?
  • Is there a way to limit the risk to partnerships holding a long term lease? How can the risk of owning a practice building be reduced?
  • How can we reduce the personal risk of employing staff, vicarious liability, and personal name and shaming of a GP (rather than the organisation as would happen with a hospital) following adverse Care Quality Commission (CQC) reports or other incidents?

Read all the key questions here

Readers' comments (9)

  • I tried explaining to my son how the NHS is a conglomerate of competing organisations. Doctors used to compete for patients before the NHS was set up and it was very much an apprentice model then. A young doctor would have to buy into a practice and earn his right to becoming a partner. Parity took years and it was fundamentally unfair. General Practice is still not recognised as a speciality(shame on RCGP) and as it still has independent contractor status it can choose what model works. The review will highlight the inadequacy of the model for the modern NHS which is looking for ACO or ICS solutions. Super partnerships will need testing in the legal sense of partnership law. With falling numbers of GP's something radical must happen to lure medics to primary care.

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  • AlanAlmond

    Joe McGilligan 3:58 ..‘The review will highlight the inadequacy of the model for the modern NHS which is looking for ACO or ICS solutions.‘

    It strikes me how frequently people assert the current partnership model ‘isn’t fit for the modern NHS’ like it’s some kind of self obvious fact without any need to explain why.

    I don’t agree. ACOs are nothing more than a convenient mechanism for the government to quietly privatise health care and get the cost off government books. We’ll all still need to pay for our heaajthcare wether it’s funded through taxation or directly as individuals. it’ll just end up more expensive on a societal level - private health care always is. Look at the USA, birth place of the ACO.

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  • Spot on UtterFool,working at scale will no compensate for severe underfunding of primary careert will just become a less satisfactory on in more ways than financial more expensive.

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  • I think many of us have looked into the future of General Practice and not liked what we saw. It has made us plan for our future so we can choose whether we stay in the new system or leave.

    Most of us who can, are RLE. The Government has a choice. It can change to working with GPs and supporting them or it can continue to alienate them and have no one to do the work.

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  • Let common sense prevail

    I agree with Utterfoool. Lose the partnership model at your peril. Partners take on enormous amounts of responsibility and risk. Without these broad shoulders primary care will become less efficient, less cost effective, and vulnerable.

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  • Fiddling while Rome burns.
    If anyone was serious about saving the partnership model there would be a substantial rise in income and drop in workload, whilst CQC, appraisal and other such useless bureaucratic tosh would be binned.
    But as this ain’t gonna happen we have to put up with papering over the cracks ideas like this.
    The game is over, let Rome burn.

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  • Spot on David. Consecutive governments have introduced policies to make partnerships unattractive: pensions for locums, compulsory BMA contract for salaried GPs at GMS practices but not APMS, CQC, etc. This announcement is just to appease the profession. The aim is to force mergers into larger units in preparation for ACOs. How else can you get rid of partnerships which are hugely efficient and popular?

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  • Even though we are so-called Independent Contractors in a partnership model, the Contract can be and is changed frequently by one side,the DOH. Such a one sided model leads to open bullying and complete abuse. Take pay per item. Our pay has fallen from £ 27 to £ 10 per consultation. This fall equals to all items we provide.
    As a locum, in a demand led world, you are almost an Independent Contractor. I have quotes from £700 to £ 400 per day, depending on time of year. Being a locum is actually very difficult in its uncertainty of work, workplace , workforce etc., but it is still preferable to partnership. No matter how much the lolly offered, GP land is controlled by the paymaster and conditions change.
    When a GP practice folds, the new Contractors get 25 to 50% more. Some GPs get £100 others £250 per patient year.
    GP partnership is inherently unfair. Until its injustices and its terrible liabilities are sorted, it is best avoided, as is evidenced by the falling numbers.

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  • Superpartnerships are a liability timebomb - I predict massive legal problems with the unlimited and joint and several liability issues

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