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Independents' Day

Don’t discount non-GP partners – ours saved the practice

Dr Tom Gillham explains how his practice benefited from having a non-GP partner get on with running the business side 

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GPs at the recent annual LMCs conference in Liverpool voted on a motion to encourage non-GPs to become partners ‘to increase the sustainability of the partnership model’. The motion was defeated. A Birmingham LMC representative stated that GPs ‘will always be the best advocate for their patients,’ adding that they ‘know what is safe practice’.

I agree with the first statement, but I cannot entirely agree with the second.

A year ago almost to the day, my partners and I sat round the table with our newest recruit to sign the latest re-working of our agreement. It had been sitting with the legal team for a while, as we – GPs and lawyer alike – found ourselves on unfamiliar territory: our new recruit was not, and never had been, a GP. Nor was he a nurse, pharmacist, or member of any one of the allied health professions.

He was, and is, a businessman.

GPs are no longer talking of having to leave and crucially, we are now safe

We’d just had a tough CQC report: inadequate monitoring of high risk drugs, substandard appraisal of our staff, incomplete policies on health and safety, insufficient audit and a raft of hitherto unknown unknowns. The finances weren’t under control either. We were working harder than ever, but were haemorrhaging GP sessions with retirements and ill health. As a busy practice with 21,000 patients and high demand, we were finding it hard to attract new GPs. We were just about able to advocate for our patients, but the practice didn’t feel safe.

Now, most surgeries manage their inspections fairly well, and we just weren’t adequately prepared. Stretched by our clinical work, we had neglected areas that the CQC considers mandatory. Not only that, partners were dabbling in other pseudo-clinical areas, which all reduce clinical capacity by taking GPs out of surgery: I was doing rotas, a partner was leading on QOF, another was ‘nurse liaison’ and a fourth was ‘financial lead’. Fewer appointments: less safe.

Health and safety, finances, recruitment, rotas, nurses, staff, QOF, enhanced services, capacity, private revenue: does any GP have any sound training in any of these areas? We are medically qualified. Our job, and we do it well, is to look after, to advocate for, our patients. We have learned the ways of practice business by doing it, but that doesn’t qualify us to do it well.

The burden of non-clinical work and administration in general practice is colossal, and will only increase. GPs cannot possibly absorb this work and good practice managers are hard to find. Besides, salaried managers will never feel as invested as managing partners who are invested in – and take ownership of – the practice business.

So in he came, as a consultant post-CQC, using words like ‘strategy’ and telling us that ‘business and operational side of the practice had to be on point’. He talked about ‘ownership of a business, responsibility, structure and engagement’ as well as ‘appraisals, audit, low lying fruit’. He could explain, simply and coherently, what a capital account was.

After a second session, as he formed a CQC ‘task force’ to ‘blitz’ the expected re-inspection a few months down the line, we agreed to approach him to offer a permanent role.

He joined us, eventually, and we signed our agreement. We sailed through CQC a few months later.

In a whirlwind year, and with our support, he’s transformed our practice. Our staff are happier and fully appraised; patients have far better access; we have clear policies and protocols; our costs have plummeted whilst new income streams have been tapped; we have hundreds of audits; our GPs are seeing patients. Contractors who were fleecing us have had their contracts re-negotiated, or terminated. In twelve months, he has more than paid for himself. GPs are no longer talking of having to leave and crucially, we are now safe.

The LMCs conference addressed practice closures. The ones that have closed are usually smaller, where economies of scale cannot apply. They can no longer practice safely. With a huge list and our own premises, we assumed we were safe. Had we been re-inspected without the help of our Managing Partner, we would have been closed down too: a big statistic, but just another casualty in a far bigger story.

Practices are businesses, like it or not. They need leaders who are business savvy, experts in the field. These business managers need ownership and should feel invested: they can only achieve their full potential as partners. We are experts in patients and we are trained to care. As practices close around us, I’ve experienced this first hand: the only sustainable model is partnerships where GPs and businesspeople share a table, as equals.

Let them look after our business, whilst we look after our patients. Safely.

Dr Tom Gillham is a GP in Hertfordshire


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Readers' comments (16)

  • Isn't this just like the practice manager becoming a partner instead of salaried? Good idea though

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  • I thought this was the point of the practice manager?

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  • Tom Gillham

    Yep, but even the best employed PMs (and there are many) cannot be as invested in the practice as a profit-sharing managing partner.

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    Richard Branson and Sir Alan would love to manage your practices

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  • Tom Gillham

    They would, but we wouldn't let them anywhere near.

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  • AlanAlmond

    I really am not convinced why you can’t just employ a practice manager. If it’s about pay, then pay them more, or be creative in the way you pay them. If you can’t afford to then you can’t afford a non clinical partner either. I don’t want to play down what you’ve achieved and I respect your sentiment entirely but I don’t see this makes a bonefide case for non clinical partners.

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  • Tom Gillham

    Why not just make them a partner? A GP-only partnership model is outdated. It's time we acknowledged we don't have the core skills/time required to run modern GP businesses. We need to care for out patients and this should be our focus.

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  • Interesting article. I don’t think it’s the only answer, but it may be an answer for some practices. Certainly there is a tendency for us to conclude we are the best people to do every job going. I enjoy the business aspects of the job too - but we can only do so much.

    I think this article is essentially praising the value of having a very strong, committed and adaptable practice manager. In your case I sense the partnership was probably just the carrot to recruit someone with top skills to the job. Linking pay to practice performance has pros but also cons - I imagine it’s critical to ensure everyone on board has a similar ethos. I know our goal isn’t profit above everything - it’s a balance of retaining reasonable drawings while offering good service.

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    Business men would like to have us working as expendable salaried staff
    (The Privatisation agenda )

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    Tom 12:31...
    Jeremy Hunt will let them

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